Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy

Neurosurgery. 2009 Mar;64(3 Suppl):ons187-93; discussion ons193-4. doi: 10.1227/01.NEU.0000335645.67282.03.


Objective: Pain, usually a response to tissue damage, is accepted as an unpleasant feeling generating a desire to escape from the causative stimulus. Although, in the early stages of malignant diseases, pain is seen in 5% to 10% of cases, this rate reaches nearly 90% in the terminal stage, and pain becomes a primary symptom. Cordotomy is one of the treatment choices in pain caused by malignancies localized unilaterally to the extremities as well as the thorax and the abdomen.

Methods: The target of computed tomography (CT)-guided percutaneous cordotomy is the lateral spinothalamic tract located in the anterolateral region of the spinal cord at the C1-C2 level. Between 1987 and 2007, CT-guided percutaneous cordotomies were performed in 207 patients; most (193 patients) suffered from intractable pain related to malignancy. The patients' pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively.

Results: The initial success rate of CT-guided percutaneous cordotomy was 92.5%. The success rate was higher in the malignancy group. In the cancer group, selective cordotomy (pain sensation denervated only in the painful region of the body) was achieved in 83%. In 12 cases, bilateral selective percutaneous cordotomy was successfully applied.

Conclusion: In the treatment of intractable pain, CT-guided cordotomy is an option in specially selected cases with malignancy. In this study, anatomic and technical details of the procedure and the experience gained from treating 207 patients over a 20-year period are discussed.

MeSH terms

  • Cordotomy / methods*
  • Humans
  • Karnofsky Performance Status
  • Neoplasms / complications*
  • Pain Measurement
  • Pain, Intractable / diagnostic imaging*
  • Pain, Intractable / etiology
  • Pain, Intractable / surgery*
  • Spinal Cord / diagnostic imaging*
  • Spinothalamic Tracts / surgery
  • Surgery, Computer-Assisted*
  • Tomography, X-Ray Computed