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PubMed1986

Sensitivity to painful and nonpainful electrocutaneous stimuli in monkeys: effects of anterolateral chordotomy.

Four Macaca nemestrina monkeys were trained to pull a manipulandum to escape electrocutaneous stimulation (ES) applied to either leg. The intensities of stimulation which the monkeys chose to escape were those that humans identify as painful. The duration of escape trials was inversely related to stimulus intensity, and the force of escape responses was directly related to ES intensity. Reflexive responses were elicited by stimulus intensities below and above the escape threshold, and the force of the flexion reflexes was a negatively accelerating function of stimulus magnitude. The monkeys were also trained to respond, for water reinforcement, to cued, low-intensity ES. The stimulus intensities detected for water reinforcement were 50-100 X less than the escape thresholds. Following unilateral, anterolateral chordotomy, all monkeys demonstrated a large reduction in percentage of escape responding to stimulation of the contralateral leg. When the animals did escape contralateral stimulation, the latencies to respond were longer than preoperatively. The percentage and latency of escape responses to stimulation of the ipsilateral leg were not changed following chordotomy. Despite the depression of contralateral pain reactivity, the animals continued to respond to low levels of stimulation on the detection task, demonstrating that anterolateral chordotomy reduced the painfulness of strong stimulation without eliminating sensibility for low levels of stimulation. However, postoperative detection thresholds were consistently higher contralaterally than ipsilaterally. This effect resulted from slight contralateral decreases and significant ipsilateral increases in sensitivity to low levels of ES (relative to preoperative values). Thus, contralateral axons in the anterolateral column contribute to detection of light cutaneous stimulation, and chordotomy appears to disinhibit inputs from large myelinated afferent fibers to ipsilateral neurons in the spinal gray matter caudal to the lesion. The strictly contralateral slowing and reduction in percentage of pain reactivity by chordotomy correlated with reports from human patients. However, reflexive measures did not suffice as indicants of pain sensitivity. The chordotomies produced bilateral attenuations of reflexive amplitudes. Also, the force of operant escape responses was reduced with stimulation of either side. Thus, the disfacilitation of motoric reactions extended both rostral and caudal to the spinal lesions that interrupted propriospinal axons in the vicinity of the ventral horns.

Animals↗

PubMed1988

Reorganization of primary afferent nerve terminals in the spinal dorsal horn of the primate caudal to anterolateral chordotomy.

A primate model has been used to explore the possibility that anterolateral chordotomy may produce intraspinal sprouting or rearrangement of primary afferent nerve terminations that could account for delayed postoperative recovery of sensory function. Monkeys were trained to limit the duration of an electrical stimulus, and the vigor and frequency of their escape responses were used to differentiate painful from nonpainful levels of stimulation. Behavioral testing after chordotomy revealed: 1) contralateral hypalgesia in all animals, with sensory recovery in half of the group, and 2) bilateral decreases in reflexive force in all animals, with reflex recovery in the majority of monkeys. At the terminal experiment, dorsal rootlets caudal to the spinal lesion were labeled bilaterally with HRP, and the distribution of labeled synaptic complexes was determined within the dorsal horn. When compared to controls, animals undergoing chordotomy showed a loss of terminals in the superficial dorsal horn and an increase of synaptic enlargements in deeper layers. These effects were bilateral, but were most pronounced on the side contralateral to chordotomy. Animals with diffuse spinal lesions showed a completely different change in the distribution of primary afferent terminals. Animals with sensory recovery demonstrated a more normal terminal distribution pattern than persistently hypalgesic monkeys, but there was considerable variability in the data, and analysis by different statistical tests yielded varying results.

Afferent Pathways↗

PubMed1976

[Open spinal operations (anterolateral chordotomy and commissural myelotomy) in modern treatment of pain (author's transl)].

The only significant open pain operations on the spinal cord itself that are routinely in use nowadays are anterolateral chordotomy and commissural myelotomy. Open thoracic chordotomy is still inidcated in cases of malignant growth in the lower body, to be sure of avoiding further neurological involvement in the upper region. Open cervical chordotomy, on the other hand, is now only indicated after unsuccessful percutaneous chordotomy and neurostimulation technics. Commissural myelotomy is still used in specific cases in specialized clinics. Despite advances in knowledge and more modern methods, the open operations still cannot be anondoned.

Chronic Disease↗

PubMed1986

Multifocal spinal angiosarcoma after chordotomy.

A male aged 60 is reported who, 5 years after chordotomy at the Th 2/3 level, developed acute paraplegia of the legs and a sensory transverse lesion due to an extradural tumour of the Th 1-4 level. Neuropathology revealed transverse necrosis of the thoracic spinal cord (Th 1-4) due to an intradural tumour at the upper thoracic and lumbar spinal levels, the thoracic malignancy arising at the site of the previous chordotomy, with a suture being observed within the tumour mass. Histology, positive immunostaining of tumour cells with Factor VIII antigen, a specific marker of endothelial cells and the ultrastructural demonstration of Weibel-Palade bodies in endothelial cells of the tumour vessels suggested a malignant mesenchymal tumour of angiosarcoma type presumably arising from the spinal meninges, and broadly invading the spinal cord. The usual relation of this extremely rare intraspinal vasoformative malignancy to previous chordotomy is discussed.

Antigens↗

PubMed2001

Percutaneous chordotomy for managing cancer pain.

Pain is a problem frequently encountered by patients with cancer. For more than 30 years, the percutaneous chordotomy procedure has been a nonpharmacological approach to the management of intractable cancer pain. Nursing care of patients before, during, and after the percutaneous chordotomy procedure is challenging. Patients and their family members need to be educated about the intent and outcomes of the procedure, as well as its complications. The purpose of this article is to review the theoretical aspect of pain perception and outline the anatomical background and basic steps of the percutaneous chordotomy procedure. Preoperative patient education and preparation, intraoperative nursing interventions, and postoperative patient care are discussed.

Cervical Vertebrae↗

PubMed1976

Hypoventilation after high unilateral cervical chordotomy in a patient with preexisting injury of the phrenic nerve.

Unilateral cervical chordotomy for the relief of intractable pain is a well accepted procedure but is not without hazard. Postoperative respiratory failure is not an uncommon occurrence, but the likelihood increases with a number of factors, particularly preexisting pulmonary abnormalities or previous contralateral cervical chordotomy. Preoperative assessment of the pulmonary function of patients who are about to have cervical chordotomy is emphasized to predict and anticipate potential postoperative respiratory failure.

Cordotomy↗

PubMed1976

[Percutaneous chordotomy for the treatment of pain. Technic, indications and results].

In the last 13 years, since the introduction of percutaneous chordotomy by Mullan et al. (1963),the method has been developed and has now a solid place in the neurosurgical management of pain problems. The lateral approach of the C1/C2 level with X-ray check, visualization of the spinal cord by means of positive contrast myelography, impedance measurement, and stimulation is the mostly used and the least complicated method. Percutaneous chordotomy should be mainly used in the management of intolerable pain in patients with malignancy. The results of 130 percutaneous chordotomies in 100 patients during the last 2 years are discussed.

Cordotomy↗

PubMed1989

The use of chordotomy to treat pain from gynecologic cancer.

Tumor growth in the pelvis with nerve involvement causes severe pain which is notoriously resistant to pharmacological treatment. Chordotomy is a classical method for the relief of pain. This is a retrospective study of 24 chordotomy cases, operated on at the department of Neurosurgery, and independently evaluated at the department of Gynecologic Oncology. Initially 19 patients (79%) were painfree whereas 4 patients (17%) had only moderate or no relief following the operation (one not evaluable). 10 patients remained free of pain until death. There were no serious complications. Possible causes of pain relapse are analysed. We conclude that chordotomy is worth consideration when facing severe pelvic cancer pain.

Cordotomy↗

PubMed1976

[Percutaneous chordotomy].

The authors review 134 cases of percutaneous cervical chordotomy in 95 patients; 86 patients suffered from malignant tumors, while the pain was caused by benign growths in only 9 cases. The immediate postoperative findings are compared with the clinical results of the follow-up medical examination. Chronological and numerical data follow on permanent sucesses and recurrence rates. The author's own morbidity and mortality rates are contrasted with those if other authors, and compared with the risk involved in open chordotomy.

Analgesia↗

PubMed1981

Substance P and leucine-enkephalin changes after chordotomy and morphine treatment.

Spinal cords of rats, cats and monkeys were transected; the animals were perfused at varying times. Other rats were injected with morphine and perfused 10 days later. Immunocytochemistry shows substance P (SP) present in control animals primarily in the substantia gelatinosa (SG) of the dorsal horn of the spinal cord. Slight SP immunoreactivity is found in the ventral horn and near the central canal. Starting a few days after transection, there is a buildup of reaction product in the dorsal horn, in sections cut from below the lesion; staining above remains the same. With time, after chordotomy, SP immunoreactivity appears in fibers in lamina V, only in sections below the lesion. Leu-enkephalin (LE) is also found in the SG, however, it is also present in quantity in the ventral horn and central canal areas. Chordotomy has no effect on its distribution indicating LE is intrinsic in the cord and probably contained within interneurons. Morphine increases SP immunoreactivity in the SG, laminae I, IV and V, and in the ventral horn, suggesting morphine analgesia is due to inhibition of intraneuronal SP release in regions specifically associated with pain--SG and lamina V.

Animals↗

PubMed1981

[Has the classic chordotomy a future? (author's transl)].

Evaluating our results of anterior-lateral chordotomy in 88 patients suffering from intractable pain, we can state that this is a useful surgical procedure. Today however it has to be replaced by the so-called percutaneous cervical chordotomy.

Humans↗

PubMed2002

A case of chondronecrosis of the epiglottis after laser chordotomy.

A 30-year-old Caucasian female patient suffering from bilateral vocal-fold immobility developed a necrosis of the epiglottis with severe respiratory distress 35 days after fiber-guided Nd:YAG-laser chordotomy on the right side. Twenty-two years prior to surgery, she had received a high-dose radiotherapy, which had caused severe scarring of the whole neck and the larynx. This necrosis is more likely an inflammatory complication than a direct side effect of the laser surgery in the radiation-altered laryngeal tissue. It underlines the importance of carefully considering the indications for laser surgery of an irradiated larynx.

Adult↗

PubMed1990

Long-term changes in purposive and reflexive responses to nociceptive stimulation following anterolateral chordotomy.

Macaca nemestrina monkeys received unilateral interruption of the spinothalamic tract, producing contralateral hypalgesia and a bilateral decrease in amplitude of the flexion reflex. These effects on operant escape and reflex responses to electrocutaneous stimulation (ES) were monitored for months to evaluate relationships between the extent of each lesion and the presence or absence of recovery from the early postoperative deficits. Before surgery, the animals were trained to perform an operant response that terminated ES to the lateral calf of either leg. The durations of ES tolerated by each monkey were inversely related to stimulus intensities within the pain sensitivity range of human subjects. The vigor of operant escape responses and the frequency of intertrial pulls of the manipulandum were directly related to stimulus intensity. Following anterolateral chordotomy at an upper thoracic level, these measures revealed a contralateral hypalgesia for each animal. Operant responsivity to stimulation contralateral to the lesion recovered to control levels for 7 animals (group R). Sustained contralateral recovery of operant reactivity was not observed for 8 monkeys (group U). Most of the lesions in groups R and U were similar in extent and location, involving the classical distribution of the spinothalamic tract (in the anterolateral and ventral columns). Thus, recovery was not determined solely by lesion configuration. However, when recovery did occur, it was associated with medially extensive lesions. A subgroup of 3 unrecovered animals received superficial lesions that did not substantially involve the gray matter or the ventral columns. For all animals, reflex magnitudes were initially diminished bilaterally and then increased over months of testing. Reflex recovery was greater for the animals that demonstrated recovery of intentional reactions to nociception (group R). An ipsilateral hyperreflexia became apparent for group R. Contralateral recovery to normal levels was observed for group R but not for group U. The time course of recovery for operant and reflex responses clearly differed, indicating that different processes determined changes in these spinal and supraspinal reactions to nociceptive stimulation.

Animals↗

PubMed1979

Consequences of experimental mitral insufficiency induced by chordotomy.

In mitral insufficiency induced by chordotomy in dogs beside the common diagnostic data the values for tissue perfusion indicative of myocardial microcirculation have been studied. Unexpectedly, a decrease of subendocardial circulation was found; this reduced circulation manifested itself with alterations such as changes in mitochondrial structure, increased quantity of subsarcolemic sarcoplasma, and degenerative symptoms.

Animals↗

PubMed1964