Cordotomy (or chordotomy) is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperature perception. This procedure is commonly performed on patients experiencing severe pain due to cancer or other diseases for which there is 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 now used exclusively for pain due to cancer where treatment to level 3 of the World Health Organisation pain ladder has proved ineffective. Cordotomy is especially indicated for pain due to asbestos-related cancers such as pleural and peritoneal mesothelioma.
A number of alternative surgical procedures have evolved in the 20th century; these include:
Commissural myelotomy, with limited rostro-caudal range; it produces bilateral analgesia (Armour 1927; Hitchcock 1970; 74).
Limited midline myelotomy for the treatment of pelvic visceral cancer pain (Gildenberg and Hirshberg, 1984).
Recently[when?], doctors at the University of Arkansas for Medical Sciences discovered a new pathway in the spinal cord relatively specific for visceral pain - the pain that originates from visceral organs such as the colon, bladder and pancreas. The new pathway is located in the posterior columns, traditionally believed to mediate light touch and kinesthesia. This discovery led to a paradigm shift in the understanding of pain pathways and in the approach to treat intractable visceral pain. As a result, punctate midline myelotomy was introduced around the world as a new surgical procedure for the treatment of visceral pain residual to cancer and refractory to conventional treatment.
- Al-Chaer ED et al. A role for the dorsal column in nociceptive visceral input into the thalamus of primates. J Neurophysiol. 1998 Jun;79(6):3143-50
- Laboratory of Elie D. Al-Chaer for the Study of Pain
- Science News Online (2/13/99): Pain, Pain, Go Away
- A CBS HealthWatch: Breakthrough In Battling Back Pain, New Procedure Just 8 Minutes To Change Your Life
- Mann, Michael. "Somesthesia - Central Mechanisms". The Nervous System in Action. Retrieved 30 May 2011.
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