Flat Panel Fluoroscopy (O-Arm) Guided Percutaneous Radiofrequency Anterolateral Cordotomy

Abstract

Abstract INTRODUCTION Chronic pain is a major cause of the current opioid epidemic in the United States. Cancer related intractable pain represents a challenging condition to manage medically. Most patients with this condition need increasingly higher doses of opioid analgesics due to receptor downregulation. This put patients at risk of opioid addiction, and it results in financial burden on both the patients and healthcare system. Anterolateral cordotomy is an ablative pain procedure that works through interrupting the ascending pain pathways contralateral to the pain site, namely the spinothalamic tract. Here, we present a case with unilateral cancer related somatic pain that was treated with a contralateral C1-C2 cordotomy. METHODS A 55-yr-old female with a stage 4 breast cancer that invaded her chest wall and axilla on the right side was studied. The tumor eroded through the skin of the breast. She has been having worsening chronic somatic pain that required hospital admission. She was using 60 mg of oral Methadone and 300 mg of Dilaudid delivered through patient control analgesia (PCA), with residual pain scored at 5 (1-10). She underwent a left sided C1-C2 O-arm guided percutaneous Radiofrequency cordotomy. RESULTS The patient had an immediate complete relief of her pain in the operating room that lasted throughout her hospital stay. On postop day 1 the Dilaudid was cut down by 50%. On postop day 2 it was stopped, and the patient was continued on oral protocol. She was discharged home on postop day 3. Neurologically the patient had no pain/temperature sensation on the right arm and chest, but she maintained motor strength, proprioception, vibration, and balance equally on both sides. CONCLUSION O-arm guided percutaneous Radiofrequency cordotomy is an effective minimally invasive method to treat chronic somatic pain. It results in immediate pain relief in 90% of patients with resultant reduction in opioids consumption and decrease hospital length of stay.