Chapter 9 - Spinal Ablation for Cancer Pain (Cordotomy and Myelotomy)

Abstract

Spinal cord ablative techniques continue to serve a role in the management of refractory cancer pain. Cordotomy is a lesion of the spinothalamic tract, which can be performed percutaneously using x-ray or CT guidance. A safe technique when performed under real-time CT guidance, cordotomy can lead to pain relief in greater than 80% of patients at 6 month follow-up with minimal morbidity. The most common complications include transient weakness in 2-5% of patients and dysesthesia in 2% of patients. Myelotomy is a lesion of the post-synaptic dorsal columns visceral pain pathway which is useful in the treatment of visceral cancer pain. The procedure can be performed by creating a mechanical lesion through a laminectomy using an open surgical technique. Myelotomy can also be performed percutaneously, with either a mechanical lesion or radiofrequency ablation. Though the clinical experience with myelotomy is small, several case series support the use of this technique for medically intractable visceral cancer pain.