Cordotomy is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperatureperception. This procedure is commonly performed on patients experiencing severe pain due to cancer or other diseases for which there are currently no cure. Anterolateral cordotomy is effective for relieving unilateral, somatic pain while bilateral cordotomies may be required for visceral or bilateral pain.
Cordotomy is usually done percutaneously with fluoroscopic guidance while the patient is under local anesthesia. Open cordotomy, which requires a laminectomy, is often risky for patients with poor medical conditions, but may be required if percutaneous cordotomy is not feasible or an attempt has failed.
Cordotomy is an effective procedure for relieving intractable pain and has been used to treat patients with unilateral pain of the lower body and lower extremities.
Computerized tomography--guided percutaneous bilateral selective cordotomy may prove to be the treatment of choice for patients suffering from bilateral cancer pain, because of the advantages of higher segmental selectivity and controlled ablation of neural structures at a higher cervical level under direct visualization.
The target in percutaneouscordotomy is the lateral spinothalamic tract in the anterolateral part of the spinal cord at the C1--2 level, although the posterolateral part of the lateral spinothalamic tract should be targeted to control pain from the lower trunk and extremities, as is done in bilateral procedures.
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