Cordotomy

Cordotomy 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 are 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 analgesic ladder has proved ineffective. Cordotomy is especially indicated for pain due to 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 ."Limited midline myelotomy" for the treatment of pelvic visceral cancer pain .Recently, Dr. Elie D. Al-Chaer and his colleagues discovered a new pathway in the spinal cord relatively specific for visceral pain - the pain that originates from visceral organs such as the colon, the bladder and the 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 our 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. (From the Wikpedia article Cordotomy.)

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Recent Publications on Cordotomy:
[Description of complications after injection laryngoplasty with polydimethylsiloxane] The injection of polydimethylsiloxane for medialization of the vocal folds...	18th June, 2009	Hopitaux Universitaire de Geneve, Service d'Oto-Rhino-Laryngologie et de	Rev Laryngol Otol Rhinol (Bord). 2009;130(1):69-72.
Laryngeal complications after lipoinjection for vocal fold augmentation. OBJECTIVES/HYPOTHESIS:: Vocal fold augmentation with autologous fat has...	13th June, 2009	Department of Otolaryngology-Head and Neck Surgery, University of Texas	Laryngoscope. 2009 Jun 11. DOI Direct Link
[Spinal cord injuries. Rehabilitative neurosurgery] OBJECTIVES/HYPOTHESIS:: Vocal fold augmentation with autologous fat has...	20th May, 2009	Neurokirurgiska Kliniken, Akademiska sjukhuset, Uppsala.	Lakartidningen. 2009 Mar 11-17;106(11):775-8.
Computed tomography-guided percutaneous cordotomy for intractable pain in malignancy. OBJECTIVE: Pain, usually a response to tissue damage, is accepted as an...	2nd May, 2009	Department of Neurosurgery, Ankara University School of Medicine, Sihhiye,	Neurosurgery. 2009 Mar;64(3 Suppl):187-93; discussion 193-4. DOI Direct Link
Five-year follow-up of a cordotomy. Percutaneous cervical cordotomy is an invasive procedure to treat severe,...	15th April, 2009	Department of Internal Medicine, University Medical Center Groningen,	Pain Res Manag. 2008 Nov-Dec;13(6):506-10.
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Cordotomy Patents:
US Patent No.	Title
6053913	Rapid exchange stented balloon catheter having ablation capabilities
6228109	Methods for treating atherosclerosis and vulnerable plaques
6235024	Catheters system having dual ablation capability
6246912	Modulated high frequency tissue modification
6267769	Trajectory guide method and apparatus for use in magnetic resonance and computerized tomographic scanners
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