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At least 19 recordsLinked to original sources
PubMed1991

Bilateral versus unilateral percutaneous high cervical cordotomy as a surgical method of pain relief.

The present report is concerned with the results of bilateral percutaneous high cervical cordotomy (60 patients) compared with those of unilateral cordotomy (161 patients). The result of pain relief is classified into 4 grades based on Hitchcock's criteria; grade 1: complete pain relief, grade 2: almost complete pain relief with slight residual pain, grade 3: persisting pain, but tolerable, grade 4: persisting pain, untolerable. In cases of bilateral cordotomy (60 patients), 76% of the cases showed grade 1, 19% being grade 2, 3% being grade 3 and 2% being grade 4. On the contrary, the unilateral cordotomy (161 patients) showed less impressive results, particularly in grade 1, namely, grade 1 being 64%, grade 2 being 18%, grade 3 being 14% and grade 4 being 4%. Clinically acceptable results (grade 1 plus grade 2) were, therefore, obtained in bilateral cordotomy (95%) as compared with unilateral cordotomy (82%). The difference in pain relief between bilateral and unilateral procedure observed in the present investigation is contrary to that reported previously by others. The possible explanation for less impressive result in regard to grade 1 of unilateral cordotomy is that unilateral cordotomy was performed in this series to alleviate the major side of patient's pain, followed by latent pain on the other side postoperatively, which is not uncommon phenomenon in cancer pain. Whereas all of the bilateral cordotomies were done either for midline pain or bilateral pain, unilateral cordotomy gave satisfactory pain relief in some cases of midline pain. Midline pain, therefore, does not necessarily require bilateral cordotomies from a clinical point of view.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Plasticity of medial gastrocnemius motor units following cordotomy in the cat.

Experiments were performed in adult cats to determine the effects of lumbar cordotomy on synaptic potentials, motoneuron membrane electrical properties, muscle-unit contractile properties, and whole-muscle histochemical properties of a heterogeneous skeletal muscle. Medial gastrocnemius (MG) motor units were examined 1 wk to 7 mo following complete transection of the lumbar spinal cord (cordotomy). Motor units were classified on the basis of their contractile properties as type FF, FI, FR, or S (8, 68). Muscle fibers were classified as type FG, FOG, or SO on the basis of histochemical staining (59). Motoneuron electrical properties (axonal conduction velocity, action-potential amplitude, rheobase, input resistance, afterhyperpolarization), group I EPSPs, and muscle-unit contractile properties (unpotentiated and potentiated twitch, unfused and fused tetanus, fatigability) were measured. Reduced numbers of type FR motor units and increased numbers of types FI + FF motor units were found in electrophysiological experiments 2 wk to 7 mo following cordotomy. Corroborative data were obtained from histochemical studies of the same MG muscles. Electrical properties of the motoneurons of each motor-unit type were normal following cordotomy. The close correspondence between motoneuron electrical properties and muscle-unit contractile properties found in normal MG muscle (68) was preserved following cordotomy. Contractile strength of muscle units of all types was severely reduced following cordotomy; partial recovery occurred 4-7 mo following cordotomy. Cross-sectional area of muscle fibers was reduced at all times investigated (2 wk to 7 mo). In three cats, homonymous group Ia single-fiber-motoneuron EPSPs were studied 1 or 2 mo following cordotomy at spinal level L4-5 or L5. EPSP amplitude and afferent-to-motoneuron projection frequency were normal. In 12 other cats, composite heteronymous group I EPSPs were studied 2 wk to 7 mo following cordotomy at various levels. Amplitude of these EPSPs was increased, dependent upon level of cordotomy and postoperative time. Hypotheses concerning the influence of motoneurons on muscle, and of muscle on motoneurons, are presented as possible mechanisms whereby the close relation between motoneuron electrical and muscle-unit contractile properties is preserved in the face of redistributed motor-unit populations.

Afferent Pathways↗
PubMedDate not supplied

[Spino-thalamic cordotomy in cancerous pain. Results of a series of 124 patients operated on by the direct posterior approach].

The authors -- about a series of 124 cancerous patients treated during the 12 last years with open spino-thalamic cordotomy for intractable pain -- have tried to evaluate effectiveness of the operation with regard to its levels in relation to the site of pain. Patients suffering median or bilateral perineo-pelvic pain, isolated or associated with algias in one or both legs (group I: 50%) underwent a bilateral C8-C6 cordotomy in one stage. Patients with the same perineo-pelvic cancers but suffering only unilateral pain (group II : 31,8%) and patients with painful cancers in the leg (group III : 3,2%), were operated on with a C7 controlateral cordotomy. Patients suffering widespread unilateral pain in the chest, isolated or associated with algias in the arm, for instance from lung or breast cancers (group IV : 15%) underwent a controlateral C2 cordotomy. There was 3,2% mortality and one paraplegia. A useful early effect(i.e. complete or partial relief) was obtained : in 85% cases (60% and 25%) for the 1st group, in only 51% (36% and 15%) for the 2nd, and in 87% (56% and 31%) for the 4th. Relief was complete in each of the 4 cases of the 3rd group. In the 2nd group 39% of patients were completely relieved of their initial unilateral pain, but complained of an early post-operative pain on the other side. This secondary pain was supposed existing prior to the operation, but masked because of its lesser intensity. The useful results at the time of death, after a 6 month mean survival (from 1 month to 4 years), were 63,75% in the 1st group, 33% in the 2nd, 100% in the 3rd and 72% in the 4th. The high rate of poor results with unilateral cervical cordotomy in the perineo-pelvic cancers with apparently unilateral pain, led us since then to systematically perform for them a bilateral cordotomy. Thus, our general management for pain of malignant origin is now as follows: C8-C6 bilateral cordotomy for all the perineo-pelvic cancers whatever uni- or bilateral the site of pain may be; C7 controlateral cordotomy for the painful cancers of the leg; and C2 controlateral cordotomy for hemithoracic and/or arm pain, when related to very extended lung or breast cancers. We prefer complete posterior rhizotomy for limited cancers of the thoracic wall, and selective posterior rhizotomy through the scope, from -- the brachial plexus roots down to T4 -- for pain as from the PANCOAST-TOBIAS syndromes, or in case of painful involvements of the upper limb roots. For cervico-facial cancers we generally use combined sections of the sensory cranial nerves in the posterior fossa and of the cervical posterior roots.

Cordotomy↗
PubMed1987

Sleep apnea following percutaneous cervical cordotomy.

Sleep apnea (Ondine's Curse) is an uncommon but potentially fatal complication of percutaneous cervical cordotomy. The authors have had the opportunity to review the case histories of 6 patients who have died of sleep apnea following this procedure. In a series of 112 patients, 144 cervical percutaneous cordotomies were performed from 1977 to 1985--80 unilateral cordotomies and 32 staged bilateral cordotomies. Six (5%) patients died as the result of sleep apnea. Five patients (16%) died following bilateral cordotomy and one (1%) patient with pulmonary disease died following unilateral cordotomy. The clinical data of these 6 patients are presented and unique spinal cord pathology is described in this report. The pathophysiology of the sleep apnea syndrome is also discussed.

Aged↗
PubMed1985

Results up to death in the treatment of persistent cervico-thoracic (Pancoast) and thoracic malignant pain by unilateral percutaneous cervical cordotomy.

The authors analyse the results up to death in 103 followed-up patients undergoing unilateral percutaneous cervical cordotomy for persistent cervico-thoracic malignant pain (45 cases of Pancoast syndrome and 58 cases of thoracic pain associated with lung cancer or metastases). On the basis of epidemiological data, relationships emerge between onset of pain, stage of cancer, patient survival and lasting efficacy of pain relief. Twenty (44%) of 45 patients with Pancoast syndrome were pain-free up to death as a result of cordotomy alone, while only 13/58 patients (22%) with thoracic pain were pain-free as a result of cordotomy alone owing to the very high incidence of mirror pain in this group of patients (42/58 patients, 72%) compared to those with Pancoast syndrome (14/45 patients, 31%). The type and intensity of mirror pain, however, were of such a nature in both groups as to be amenable to control with analgesic drugs. In both groups of patients, there was a low incidence of the causes of post-cordotomy pain recurrence contralateral to the lesion, i.e., deafferentation pain, fading of analgesia, and pain above the levels up to which deep pin-prick analgesia had been obtained. Cordotomy alone or, as necessary, in conjunction with analgesic drugs afforded complete pain control in 34/45 patients (75%) with Pancoast syndrome and in 50/58 patients (86%) with thoracic pain. These data provide evidence of the unique usefulness of the procedure in controlling otherwise intractable persistent cervicothoracic malignant pain, when the technique is correctly performed.

Cordotomy↗
PubMed1991

Chronic pain: a PET study of the central effects of percutaneous high cervical cordotomy.

We have studied 5 patients with unilateral, severe chronic pain due to cancer before and after percutaneous, ventrolateral cervical cordotomy to investigate the central effects of the procedure. The aim was to identify the functional anatomical correlates of abolishing unilateral nociceptive input to the brain. Patients were investigated by positron emission tomography using C15O2 to evaluate cerebral blood flow. Comparisons were made between the patients with unilateral pain before cordotomy and normal volunteers. These demonstrated significantly less blood flow in 3 out of 4 of the individual quadrants of the hemithalamus contralateral to the side of pain (P less than 0.01-0.05). These differences were abolished by cordotomy. Comparison of the patients before and after cordotomy showed a significant decrease in blood flow in the dorsal anterior quadrant of the thalamus contralateral to the side of pain (P less than 0.05) which was normalised after cordotomy. There were no significant changes in the prefrontal or primary somatosensory cortex. We conclude that chronic pain results in a decrease of synaptic activity at thalamic level either from decreased activity in neurones projecting to that region and/or attenuated local neuronal firing. We have demonstrated no secondary remote effects in cortex, indicating the importance of subcortical mechanisms in central responses to chronic pain.

Aged↗
PubMed1981

[Percutaneous cordotomy. Actual situation in pain surgery (author's transl)].

A personal experience with 138 percutaneous cordotomies is presented. The results and complications are compared to those of 49 open cordotomies at C1-C2 level. It is concluded that the percutaneous technique has better results and less complications. Nevertheless the percutaneous cordotomy is sometimes hazardous and presents some inconvenience. For this reason the author prefers in certain cases open cordotomy in a modified microsurgical technique which is described. It is outlined that in the authors opinion cordotomy should be restricted to cancer pain.

Cordotomy↗
PubMedDate not supplied

Percutaneous cervical cordotomy.

Percutaneous cervical cordotomy provides a nonoperative opportunity to interrupt the lateral spinothalamic pathways in patients with pain who are not good operative risks for an open cordotomy. The technique is relatively simple, but requires some practice. Indications should be the same as for open cordotomy, with critical patient selection. Results are comparable to those of surgical cordotomy.

Cordotomy↗
PubMed1985

[A new apparatus and stereotactic method for percutaneous high cervical cordotomy].

The authors devised a stereotactic apparatus for percutaneous cordotomy based on the experience of 191 percutaneous high cervical cordotomies on 150 patients suffering from intractable pain. This apparatus has two major components. One is a head and neck holder and the other is a guide and marker system. The head and neck holder contains fixed neck holder and head holder which can be movable in vertical direction. Using these holders, the operator can keep the patient's neck in neutral position. The marker system contains two markers of origin and a 10mm scale which indicates center line as well. The guide system, stereotactically designed, is movable in three direction and acrylic guide groove is attached. The guide needle for percutaneous cordotomy is inserted along the guide groove. The guide and marker system can be attached in both sides of the head and neck holder, therefore, the operator can insert the needle in both sides of the patient. This apparatus makes it possible to locate the target stereotactically for percutaneous cordotomy, since location of the inserted needle can be determined with the aid of cervical X-ray, even if there is no image intensifier of TV display screen available. Therefore it can be possible to reduce the X-ray exposure of the patient.

Cordotomy↗
PubMed1987

High dorsal column cordotomy plus subdiaphragmatic vagotomy prevents acute ionizing radiation sickness in cats.

Our purpose was to determine the effects on acute radiation sickness of interrupting afferent neural pathways that converge upon the medullary vomiting center but which bypass the emetic chemoreceptor trigger zone in the area postrema. A comparison was made of the vomiting response and other signs of sickness in three groups of chronic cats surgically prepared as follows: high spinal cord section of the dorsal columns, subdiaphragmatic vagotomy, and the combination of procedures. Every cat was exposed over the whole body to 45 Gy 60Co gamma-radiation which was effective in evoking emesis in 11 of 12 normal cats. Neither cordotomy alone (8 cats) nor vagotomy alone (2 cats) reliably blocked the vomiting response but they separately delayed its onset. On the other hand, the cordotomy prevented the loss of appetite and behavioral malaise that was invariably caused by the irradiation in normal cats. Finally, the combination of cordotomy and vagotomy protected all of 3 cats against the entire radiation syndrome. These cats then vomited appropriately in response to the injection of deslanoside which induces emesis through an action on the area postrema. Histological examination of the lower medulla revealed no damage of the area postrema resulting from the cordotomies. We conclude that acute radiation sickness in the cat is signaled through afferent neural pathways originating in the abdomen and that the area postrema does not participate in the causation of this syndrome.

Animals↗
PubMed1987

A mechanism of new pain following cordotomy; reference of sensation.

An antero-lateral cordotomy was performed on a 62-year-old man who had been suffering from intractable right chest pain caused by lung cancer. Six hours after the cordotomy a new pain occurred in an analogous part of the body on the opposite side; the intensity increased gradually and it became as severe as the original within 1 week. Reference of sensation from analgesic area of cordotomy to the opposite side of the body was induced by noxious stimuli. Intrathecal phenol block to the nerves conveying the cancer pain abolished the new pain and the reference of sensation from this blocked area, though it remained unchanged in other analgesic areas of cordotomy. This substantiates that the new pain was a reference of the original cancer pain.

Electrocoagulation↗
PubMed1995

Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients.

PURPOSE AND METHODS: The safety of percutaneous cervical cordotomy (PCC) and bilateral percutaneous cervical cordotomy (BPCC) was studied in 62 and 18 patients, respectively, with intractable malignant pain. Cordotomy was indicated for pain that did not respond to any other therapy. RESULTS: After PCC, 54 patients showed satisfactory, six partial, and two no pain relief. Concerning major permanent complications, urinary retention, hemiparesis, and mirror-image pain occurred in four (6.5%), five (8.1%), and four (6.5%) patients, respectively. After BPCC, nine patients showed satisfactory, six partial, and three no pain relief. The major permanent complications were the same as after PCC, and occurred in two (11.1%), two (11.1%), and one (5.6%) patient, respectively. Sleep-induced apnea was not observed in any patient. CONCLUSION: In the treatment of intractable malignant pain, localized unilaterally, if other symptomatic management fails, PCC is a recommendable procedure, particularly when pain due to movement dominates. However, due to the high incidence of complications combined with the high failure rate, BPCC is not recommended.

Adult↗
PubMed1983

Long-term efficacy of surgical cordotomy in intractable non-malignant pain.

Our results show that about 40% of patients who have cordotomies for non-malignant pain gain a prolonged and worthwhile period of relief, allowing a return to work and normal living. The available evidence, though scanty, suggests that the decline in the analgesic efficacy of cordotomy tends to 'plateau' with the passage of time, though the exact pattern of this change remains undefined. We conclude that, while the complication rate of cordotomy is undoubtedly high, and its effectiveness far from ideal, it may nevertheless have a place in the treatment of carefully selected patients with intractable pain due to non-malignant causes.

Adult↗
PubMed1989

CT-guided percutaneous cordotomy.

Percutaneous cordotomy is a commonly applied and effective procedure among the ablative pain surgeries. As plain X-ray does not permit visualization of the target relative to the electrode the chances of obtaining good results are decreased and the risk of complications are increased. The use of CT has been found to be useful in cordotomy. The procedure is performed under CT control on the patients who have previously been given 5 ml iohexol into the subarachnoid space. The needle electrode is manipulated by free hand technique. It is possible to measure the diameter of the spinal cord and to detect cord dislocation in the spinal canal. When the electrode system is introduced it is possible to visualize the tip of the electrode which is pushing or puncturing the spinal cord. As the procedure directly visualizes the relation of the electrode to the target it is possible to place the electrode in the lateral spinothalamic tract. Another advantage of the procedure is to enable us to visualize haematomas or other changes that may result from the cordotomy. The application of the technique and clinical results will be presented.

Electrocoagulation↗
PubMed1984

The cause of failure in high cervical percutaneous cordotomy: an analysis.

Factors that might have contributed to failure of high cervical percutaneous cordotomy in 23 patients with intractable pain were investigated. Cordotomy failed in 3 patients, 20 had initially good pain relief (87%). True recurrence occurred in 5 patients, 3 of them developed pain elsewhere. Analysis of these three types of failure showed a purely technical cause in 2 cases; other failures or recurrences were due to the underlying disease being not strictly unilateral, or possibly to the existence of other ascending pathways carrying nociceptive impulses apart from the spinothalamic tract. There was no influence of age, sex, type of cancer or previous medication on the result of percutaneous cordotomy. Patients with plexus involvement did better than those with bone metastasis.

Aged↗
PubMed1988

Cordotomy-denervation interactions on contractile and myofibrillar properties of fast and slow muscles in the rat.

Cordotomy-denervation interactions were studied on contractile and myofibrillar properties of slow (soleus) and fast (extensor digitorum longus) muscles of the rat. The spinal cord was transected midthoracically in neonatal (2-day-old) animals. Two months after birth, a unilateral transection of the sciatic nerve was carried out in both cordotomized and control animals. Five weeks after denervation, contractile properties were tested isometrically in vitro; myofibrillar properties were assessed by histochemical staining of the muscle fibers and by electrophoretic analysis of the myosin heavy chain composition. The following results were obtained: (i) In cordotomized animals the contraction time of the soleus was significantly shorter (-23.3% on average) than that in the control animals and this shortening was accompanied by a proportional slow-to-fast shift in myofibrillar properties. (ii) The extensor digitorum longus properties were not significantly different in the control and cordotomized animals. (iii) Denervation in control animals was followed by a marked increase of contraction and half-relaxation times in the extensor digitorum longus, whereas in the soleus only the half-relaxation time was significantly increased; myofibrillar properties in the soleus showed an appreciable slow-to-fast shift, whereas in the fast muscle the main change was an increase in type 2A fibers to the detriment of type 2B. (iv) In cordotomized animals, denervation caused the soleus contraction time to increase to control values, whereas myofibrillar properties shifted to an even faster pattern; in the extensor digitorum longus denervation caused the same changes seen in the control animals. The results showed that cordotomy at birth caused the soleus to develop as a faster muscle than in the control animals. The concurrent effects of cordotomy and denervation on the myofibrillar properties of the soleus suggest that the slow-to-fast change in these properties is a common consequence of the reduction in the level of motor activity. The opposite effects of the two experimental conditions in the soleus contraction time support the view that the contractile alterations that follow denervation mainly reflect alterations in the muscle activation process.

Animals↗
PubMed1979

Loss and recovery of reactivity to noxious stimuli in monkeys with primary spinothalamic cordotomies, followed by secondary and tertiary lesions of other cord sectors.

Cebus albifrons monkeys were trained to escape electrical stimulation of either leg at five intensities, spanning a range from mild tingle to intense but tolerable pain, as judged by human observers who experienced the same stimuli. The average duration of stimulation received by the animals at each intensity was plotted for each leg during the period required for recovery of responsiveness to noxious electrical stimulation following ventrolateral spinal cordotomy. Recovery of escape responding was observed similarly following subsequent lesions to the spinal cord, in an attempt to define the pathways that subserve pain conduction after readjustment from cordotomies that produced substantial deficits of escape behaviour. The most enduring elevations of duration of stimulation by lesion I (left cordotomy) were produced by lesions that involved all of the ventrolateral column and most or all of one or both ventral columns. Secondary lesions of the dorsal columns, Lissauer's tract and the dorsolateral columns, in various combinations, did not produce long-term effects on escape responding. In contrast, a complete ventral hemisection produced a pronounced bilateral deficit that did not recover fully over three hundred and five post-operative days. The major conclusions are: (1) that the dorsal pathways do not play a major role in the rostral conduction of information critical for pain perception in monkeys, even though these pathways receive input from high threshold receptors; and (2) in order to produce a lasting decrease of pain sensitivity in primates by spinal surgery, the lesion must be bilateral and must involve both the ventrolateral and ventral columns.

Animals↗
PubMed1990

Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation.

Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6-132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a "last resort".

Adult↗