1084 Spinothalamic Tract Cordotomy and Commissural Myelotomy for Intractable Pain: A Case Series

Abstract

INTRODUCTION: Intractable pain associated with metastatic cancer has a large impact on the quality of life of palliative patients. Spinothalamic Tract Cordotomy and Commissural Myelotomy can aim to improve the quality of life when other therapeutic options have failed. METHODS: A case series of 14 patients who underwent Spinothalamic Tract Cordotomy (N = 11) or Commissural Myelotomy (N = 3) between August 2011 and November 2022 for intractable pain from metastatic disease to the abdomen, spine or pelvis in Wellington Regional Hospital. The patients aged 25 - 82 had been referred from the local pain service or palliative care team for consideration of palliative surgical management of their pain. A review of the medical records of each patient from their admission and follow up as well as pain team and palliative care records has been undertaken to determine the effectiveness of these procedures in managing pain and to identify complications, primarily deficits affecting their ability to ambulate or quality of life. RESULTS: Of the 14 patients, 10 patients had improvement in their symptoms, ranging from excellent (defined as significant or complete resolution of pain) to good relief (pain still present but improvement in quality of life). Of those without clear improvement in their symptoms, 2 patients passed away within 5 days of their procedure due to the underlying pathology. 4 of the 14 patients had a new deficit that affected their pre-op ambulatory status however each of these had excellent improvements in their symptoms. CONCLUSIONS: Spinothalamic Cordotomy and commissural Myelotomy can offer effective pain relief to the appropriately selected patient when counselled about the potential risks to mobility.