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:
Mechanosensitive primary bladder afferent activity in rats with and without spinal cord transection. PURPOSE: Spinal cord injury induces functional and morphological changes...	31st October, 2009	Departments of Urology, Faculty of Medicine, University Antwerp, Wilrijk,	J Urol. 2009 Nov;182(5):2504-10. Epub 2009 Sep 17. DOI Direct Link
Vocal fold paralysis: role of bilateral transverse cordotomy. Objective:Although modern endoscopic laser techniques aim to avoid a...	11th September, 2009	Department of Otolaryngology, York Hospital, UK.	J Laryngol Otol. 2009 Sep 10:1-4. DOI Direct Link
Laryngeal complications after lipoinjection for vocal fold augmentation. OBJECTIVES/HYPOTHESIS: Vocal fold augmentation with autologous fat has...	29th August, 2009	Department of Otolaryngology, University of Texas Health Science Center at	Laryngoscope. 2009 Aug;119(8):1652-7. DOI Direct Link
[Description of complications after injection laryngoplasty with polydimethylsiloxane] The injection of polydimethylsiloxane for medialization of the vocal folds...	6th August, 2009	Hopitaux Universitaire de Geneve, Service d'Oto-Rhino-Laryngologie et de	Rev Laryngol Otol Rhinol (Bord). 2009;130(1):69-72.
Fractionated radiosurgical management of intramedullary spinal cord metastasis: A case report and review of the literature. OBJECTIVE AND IMPORTANCE: Intramedullary spinal cord metastasis (ISCM)...	31st July, 2009	Department of Radiation Oncology, University of Pittsburgh Cancer	Clin Neurol Neurosurg. 2009 Dec;111(10):858-61. Epub 2009 Jul 28. DOI Direct Link
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Cordotomy Patents:
US Patent No.	Title
6068645	Filter system and methods for removing blood clots and biological material
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
6267770	Remote actuation of trajectory guide
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