Cordotomy

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 incurable diseases. Anterolateral cordotomy is effective for relieving unilateral, somatic pain while bilateral cordotomies may be required for visceral or bilateral pain.

Indications

Cordotomy is performed as for patients with severe intractable pain, usually but not always due to cancer. Being irreversible and relatively invasive, corodotomy is used exclusively for pain where treatment to level 3 of the World Health Organisation pain ladder (i.e., use of major opiates such as morphine) has proved inadequate. Cordotomy is especially indicated for pain due to asbestos-related cancers such as pleural and peritoneal mesothelioma.

Procedure

Most cordotomies are now performed percutaneously with fluoroscopic or CT guidance while the patient is awake under local anesthesia. The spinothalamic tract is normally divided at the level C1-C2.