Percutaneous Cervical Cordotomy Research Articles

Cordotomy under general anesthesia for a pediatric palliative patient: illustrative case.

Computed tomography (CT)-guided cordotomy has been shown to be a safe and effective method for treating cancer pain in adults in a palliative care setting. Its effectiveness has been rarely reported in children. During cordotomy, patient feedback is considered essential. Unfortunately, in this report, the featured patient's age and demeanor precluded an awake cordotomy. The authors report the first case, to their knowledge, of percutaneous cordotomy with the patient under general anesthesia. An 11-year-old boy with osteosarcoma of the right pelvis presented with medically refractory unilateral nociceptive pain. The pain prevented ambulation, interfered with sleep, was the focus of his concern, and could not be relieved without sedation. A left percutaneous CT-guided cervical cordotomy while he was under general anesthesia was performed without complication and provided sufficient pain relief to allow ambulation and restorative sleep. Pain was no longer an issue for the patient and his family. CT-guided percutaneous cervical cordotomy can be accomplished in a pediatric patient under general anesthesia. The risks of cordotomy under general anesthesia without patient feedback must be weighed against the opportunity to improve palliative care. https://thejns.org/doi/abs/10.3171/CASE2427.

Optimization of Radiofrequency Needle Placement in Percutaneous Cordotomy Using Electromyography in the Deeply Sedated Patient.

Cordotomy, the selective disconnection of the nociceptive fibers in the spinothalamic tract, is used to provide pain palliation to oncological patients suffering from intractable cancer-related pain. Cordotomies are commonly performed using a cervical (C1-2) percutaneous approach under imaging guidance and require patients' cooperation to functionally localize the spinothalamic tract. This can be challenging in patients suffering from extreme pain. It has recently been demonstrated that intraoperative neurophysiology monitoring by electromyography may aid in safe lesion positioning. The aim of this study was to evaluate the role of compound muscle action potential (CMAP) in deeply sedated patients undergoing percutaneous cervical cordotomy (PCC). A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy while deeply sedated between January 2019 and November 2022 in 2 academic centers. The operative report, neuromonitoring logs, and clinical medical records were evaluated. Eleven patients underwent PCC under deep sedation. In all patients, the final motor assessment prior to ablation was done using the electrophysiological criterion alone. The median threshold for evoking CMAP activity at the lesion site was 0.9 V ranging between 0.5 and 1.5 V (average 1 V ± 0.34 V SD). An immediate, substantial decrease in pain was observed in 9 patients. The median pain scores (Numeric Rating Scale) decreased from 10 preoperatively (range 8-10) to a median 0 (range 0-10) immediately after surgery. None of our patients developed motor deficits. CMAP-guided PCC may be feasible in deeply sedated patients without added risk to postoperative motor function. This technique should be considered in a group of patients who are not able to undergo awake PCC.

Lesions to both somatic and affective pain pathways lead to decreased salience network connectivity.

Human pain is a salient stimulus composed of two main components: a sensory/somatic component, carrying peripheral nociceptive sensation via the spinothalamic tract and brainstem nuclei to the thalamus and then to sensory cortical regions, and an affective (suffering) component, where information from central thalamic nuclei is carried to the anterior insula, dorsal anterior cingulate cortex and other regions. While the sensory component processes information about stimulus location and intensity, the affective component processes information regarding pain-related expectations, motivation to reduce pain and pain unpleasantness. Unlike investigations of acute pain that are based on the introduction of real-time stimulus during brain recordings, chronic pain investigations are usually based on longitudinal and case-control studies, which are limited in their ability to infer the functional network topology of chronic pain. In the current study, we utilized the unique opportunity to target the CNS's pain pathways in two different hierarchical locations to establish causality between pain relief and specific connectivity changes seen within the salience and sensorimotor networks. We examined how lesions to the affective and somatic pain pathways affect resting-state network topology in cancer patients suffering from severe intractable pain. Two procedures have been employed: percutaneous cervical cordotomy (n = 15), hypothesized to disrupt the transmission of the sensory component of pain along the spinothalamic tract, or stereotactic cingulotomy (n = 7), which refers to bilateral intracranial ablation of an area in the dorsal anterior cingulate cortex and is known to ameliorate the affective component of pain. Both procedures led to immediate significant alleviation of experienced pain and decreased functional connectivity within the salience network. However, only the sensory procedure (cordotomy) led to decreased connectivity within the sensorimotor network. Thus, our results support the existence of two converging systems relaying experienced pain, showing that pain-related suffering can be either directly influenced by interfering with the affective pathway or indirectly influenced by interfering with the ascending spinothalamic tract.

Temporal Summation Predicts De Novo Contralateral Pain After Cordotomy in Patients With Refractory Cancer Pain.

Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood. To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes. Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale). All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037). The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.

Cervical Cordotomy for Intractable Pain: Do Postoperative Imaging Features Correlate with Pain Outcomes and Mirror Pain?

Percutaneous cervical cordotomy offers relief of unilateral intractable oncologic pain. We aimed to find anatomic and postoperative imaging features that may correlate with clinical outcomes, including pain relief and postoperative contralateral pain. We prospectively followed 15 patients with cancer who underwent cervical cordotomy for intractable pain during 2018 and 2019 and underwent preoperative and up to 1-month postoperative cervical MR imaging. Lesion volume and diameter were measured on T2-weighted imaging and diffusion tensor imaging (DTI). Lesion mean diffusivity and fractional anisotropy values were extracted. Pain improvement up to 1 month after surgery was assessed by the Numeric Rating Scale and Brief Pain Inventory. All patients reported pain relief from 8 (7-10) to 0 (0-4) immediately after surgery (P = .001), and 5 patients (33%) developed contralateral pain. The minimal percentages of the cord lesion volume required for pain relief were 10.0% on T2-weighted imaging and 6.2% on DTI. Smaller lesions on DWI correlated with pain improvement on the Brief Pain Inventory scale (r = 0.705, P = .023). Mean diffusivity and fractional anisotropy were significantly lower in the ablated tissue than contralateral nonlesioned tissue (P = .003 and P = .001, respectively), compatible with acute-phase tissue changes after injury. Minimal postoperative mean diffusivity values correlated with an improvement of Brief Pain Inventory severity scores (r = -0.821, P = .004). The average lesion mean diffusivity was lower among patients with postoperative contralateral pain (P = .037). Although a minimal ablation size is required during cordotomy, larger lesions do not indicate better outcomes. DWI metrics changes represent tissue damage after ablation and may correlate with pain outcomes.

Percutaneous Cervical Cordotomy for the Treatment of Cancer Pain: A Prospective Case Series of 52 Patients with a Long-Term Follow-Up.

The aim of this study is to describe the effects of percutaneous cervical cordotomy (PCC) on pain, opioid consumption, adverse events, and satisfaction in palliative care patients with cancer pain after PCC until end of life. This is a prospective observational case series of 58 PCCs in 52 consecutive patients. Indication for PCC was unilateral cancer pain with a maximum numeric rating scale (NRS) of pain above 5 despite maximal conservative treatment. The PCC was fluoroscopy guided. A radiofrequency lesion was made at 95°C for 20seconds. The pain location and pain scores, analgesic medication, the cranial and caudal borders of dermatomes hypoesthetic for pin pricks, dysesthesia, urinary retention, Horner's syndrome, muscle strength, Karnofsky performance scale (KPS) score, patient satisfaction, hospital anxiety and distress score (HADS), and RAND 36 score were evaluated at 1day; 1 and 6weeks; and 3, 6, 9, 12 18, and 24months after PCC, or until death if death occurred during the follow-up period. Pain relief after PCC was intense (change in median maximum NRS from 9 to 0) and persistent. Median opioid use per day was 240mg (145 to 565mg) before PCC and 55mg (0 to 120mg) after PCC. The upper and lower borders of dermatomes hypoesthetic for pin pricks were stable over time. The most common side effects were short-term (<1week) neck pain (28%), dysesthesia (40%), and mild loss of muscle strength (11%). Approximately 83% of the patients were satisfied or very satisfied with the results of PCC 1week after the procedure, and this percentage remained high in the long term. There was no significant change in the KPS score, HADS, and RAND 36 score. Percutaneous cervical cordotomy is an effective treatment for unilateral cancer pain. The reduction in pain, reduction in opioid consumption, and hypoesthetic area remain stable until death.

Percutaneous cervical cordotomy for cancer-related pain: prospective multimodal outcomes evaluation

BackgroundPercutaneous cervical cordotomy (PCC) offers pain relief to patients with unilateral treatment-refractory cancer-related pain. There is insufficient evidence about any effects of this intervention on patients’ quality of life.MethodComprehensive multimodal...

Intraoperative Neurophysiology for Optimization of Percutaneous Spinothalamic Cordotomy for Intractable Cancer Pain.

Percutaneous ablation of the cervical spinothalamic tract (STT) remains a therapeutic remedy for intractable cancer pain. However, it is accompanied by the risk of collateral damage to essential spinal cord circuitry, including the corticospinal tract (CST). Recent studies describe threshold-based mapping of the CST with the objective of motor bundle preservation during intramedullary spinal cord and supratentorial surgery. To assess the possibility that application of spinal cord mapping using intraoperative neuromonitoring in percutaneous cordotomy procedures may aid in minimizing iatrogenic motor tract injury. We retrospectively reviewed the files of 11 patients who underwent percutaneous cervical cordotomy for intractable oncological pain. We performed quantitative electromyogram (EMG) recordings to stimulation of the ablation needle prior to the STT-ablative stage. We compared evoked motor and sensory electrical thresholds, and the electrical span between them as a reliable method to confirm safe electrode location inside the STT. Quantified EMG data were collected in 11 patients suffering from intractable cancer pain. The threshold range for evoking motor activity was 0.3 to 1.2 V. Stimulation artifacts were detected from trapezius muscles even at the lowest stimulation intensity, while thenar muscles were found to be maximally sensitive and specific. The minimal stimulation intensity difference between the motor and the sensory threshold, set as "Δ-threshold," was 0.26 V, with no new motor deficit at 3 days or 1 month postoperatively. Selective STT ablation is an effective procedure for treating intractable pain. It can be aided by quantitative evoked EMG recordings, with tailored parameters and thresholds.

Percutaneous cervical cordotomy for cancer-related pain: national data

ObjectivesPercutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess...

Defining the Somatotopy of the Human Spinothalamic Tract: Computed Tomography Guided Mapping and Physiologic Responses in Patients Undergoing Awake Percutaneous Cervical Cordotomy

Abstract INTRODUCTION There exist 2 very different models of somatotopic organization of the spinothalamic tract (STT) in the literature: medial-to-lateral and anterior-to-posterior lamination. After correlating in Vivo macrostimulation-induced pain or temperature sensation during percutaneous cervical cordotomy with simultaneous computed tomography (CT) imaging of the electrode tip location, we present a modern description of the somatotopy of the human cervical spinothalamic tract. METHODS A total of 20 patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation were recorded and the electrode location for each response was documented with a contemporaneous CT scan. RESULTS Clinically the patients did well. Maximal daily pain on the contralateral side was significantly reduced (P &lt; .001, paired t-test) from a preoperative 9.3 ± 0.5 (VAS mean ± sd) to 0.5 ± 1.2 on the first postoperative day. The average reduction in opiate medications, as measured by morphine equivalents, was 75% over 1 wk (range 40%-98%). Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially. CONCLUSION Our work simultaneously combined awake physiologic localization of fibers within the human spinothalamic tract with neuroimaging documenting their precise anatomical localization within the spinal cord. The resultant map of the STT demonstrates, for the first time, that fibers from the lower limb are located superficially and posteriorly within the anterolateral cord with the fibers from the upper limb surrounding them primarily deep and anteriorly but also posteriorly. If these results are confirmed by others, it will solve the century-long controversy of lamination patterns within the STT and add a small but fundamental piece of knowledge to our understanding of human neuroanatomy.

Somatotopic organization of the human spinothalamic tract: in vivo computed tomography-guided mapping in awake patients undergoing cordotomy.

The location of the human spinothalamic tract (STT) in the anterolateral spinal cord has been known for more than a century. The exact nature of the neuronal fiber lamination within the STT, however, remains controversial. After correlating in vivo macrostimulation-induced pain/temperature sensation during percutaneous cervical cordotomy with simultaneous CT imaging of the electrode tip location, the authors present a modern description of the somatotopy of the human cervical STT. Twenty patients underwent CT-guided percutaneous cervical cordotomy to alleviate contralateral medication-refractory cancer pain. Patient responses to electrical stimulation (0.01-0.1 V, 50 Hz, 1 msec) were recorded and the electrode location for each response was documented with a contemporaneous CT scan. In a post hoc analysis of the data, the location for each patient's response(s) was measured and drawn on a diagram of their cord. Positive responses were represented only when the lowest possible voltage (≤ 0.02 V) elicited a response. Negative responses were recorded if there was no clinical response at 0.1 V. Clinically, patients did well with an average reduction in opiates of 75% at 1 week, and 67% were able to leave the palliative care unit. The size of the cervical cord varied between patients, with an average lateral extent (width) of 11 mm and a height of 9 mm. Responses from the lower limb were represented superficially (lateral) and posteriorly within the anterolateral cord. The area with responses from the upper limb was larger and surrounded those with responses from the lower limb primarily anteriorly and medially, but also posteriorly. In this study, the somatotopic organization of the human STT was elucidated for the first time using in vivo macrostimulation and contemporaneous CT imaging during cordotomy. In this cohort of patients, the STT from the lower-limb region was located superficially and posteriorly in the anterolateral quadrant of the cervical cord, with the STT from the upper-limb region surrounding it primarily anteriorly and medially (deep) but also posteriorly. The authors discuss how the previous methods of cordotomy may have biased the earlier versions of STT lamination. They suggest that an ideal spinal cord entry site for cordotomy of either the upper- or lower-limb pain fibers is halfway between the equator and anterior pole of the cord.

Poster 337: Percutaneous Radiofrequency Cervical Cordotomy for the Treatment of Refractory Cancer Associated Leg Pain: A Case Series

PM&RVolume 10, Issue 9S1 p. S111-S112 Poster 337: Percutaneous Radiofrequency Cervical Cordotomy for the Treatment of Refractory Cancer Associated Leg Pain: A Case Series Siddarth Thakur MD, Siddarth Thakur MD University of Texas MD Anderson Cancer Center, Houston, TX, United StatesSearch for more papers by this authorThomas Chai MD, Thomas Chai MDSearch for more papers by this authorAshwin Viswanathan, Ashwin ViswanathanSearch for more papers by this authorDhanalakshmi Koyyalagunta MD, Dhanalakshmi Koyyalagunta MDSearch for more papers by this author Siddarth Thakur MD, Siddarth Thakur MD University of Texas MD Anderson Cancer Center, Houston, TX, United StatesSearch for more papers by this authorThomas Chai MD, Thomas Chai MDSearch for more papers by this authorAshwin Viswanathan, Ashwin ViswanathanSearch for more papers by this authorDhanalakshmi Koyyalagunta MD, Dhanalakshmi Koyyalagunta MDSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1016/j.pmrj.2018.08.349Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue9S12018 AAPM&R Annual Assembly AbstractsSeptember 2018Pages S111-S112 RelatedInformation

C.06 Somatotopic organization of the human spinothalamic tract: CT-guided mapping in awake patients undergoing cordotomy

Background: After correlating in vivo macrostimulation-induced pain or temperature sensation during percutaneous cervical cordotomy with simultaneous CT imaging of the electrode tip location, we present a modern description of the somatotopy of the human cervical spinothalamic tract Methods: Twenty patients with medically refractory, unilateral, nociceptive pain due to malignancy received contralateral cervical percutaneous cordotomy. In a post-hoc analysis of the data, each individual’s cervical spinal cord was measured from the CT image using PACS software. The location of the electrode tip during each stimulation-induced response was then superimposed on a diagram of their cord Results: The lower limb responses were found more superficial and posterior to those of the upper limb. Interestingly, the region for upper limb responses surrounded that for lower limb primarily anteriorly and medially (deep) but also posteriorly Conclusions: This work simultaneously combined awake physiologic localization of fibers within the human -spinothalamic tract (STT) with neuroimaging documenting their precise anatomical localization within the spinal cord. The resultant map of the STT demonstrates, for the first time, that fibers from the lower limb are located superficially and posteriorly within the anterolateral spinal cord with the fibers from the upper limb surrounding them primarily deep and anteriorly but also posteriorly

Microstructural mechanisms of analgesia in percutaneous cervical cordotomy revealed by diffusion tensor imaging

The purpose of this study is to demonstrate the potential of diffusion tensor imaging (DTI) to reveal structural mechanisms underlying spinal ablative procedures, including percutaneous radiofrequency cordotomy (PRFC). PRFC is a surgical procedure that produces analgesia through focal ablation of the lateral spinothalamic tract (STT), thereby interrupting the flow of pain information from the periphery to the brain. To date, studies regarding mechanisms of analgesia after PRFC have been limited to postmortem cadaveric dissection and histology. However, with recent advances in DTI, the opportunity has arisen to study the STT non-invasively in vivo. In this technical note, an individual with successful pain relief following unilateral STT PRFC was examined using DTI, with the contralateral STT serving as an internal control. PRFC substantially reduced rostrocaudal directional DTI signal in the STT from the lesion in the cervical spinal cord through the pons and mesencephalon. Our findings confirm that focal ablation and anterograde degeneration accompany the analgesic effects of PRFC. In vivo imaging of the STT with DTI may contribute to surgical targeting for PRFC procedures, better understanding of the therapeutic and untoward effects of PRFC, and a deeper understanding of spinothalamic contributions to nociception.

Percutaneous cervical cordotomy in cancer pain.

The aim of this study was to review all published articles in the literature in English regarding percutaneous cervical cordotomy in cancer pain. Percutaneous cordotomy may be used to relieve unilateral pain below the level of the neck arising from a variety of causes. It is particularly indicated for unilateral chest pain associated with malignant disease. We searched for reports on MEDLINE and EMBASE using the terms 'percutaneous cordotomy', 'fluoroscopy', 'computed tomography,' and 'cancer pain' up to and including 2013. Reports were also located through references of articles. This review leads us to conclude that percutaneous cervical cordotomy can be recommended even before considering the use of strong opioids.

CT-Guided High-Level Percutaneous Cervical Cordotomy for Intractable Cancer Pain.

To evaluate the safety and effectiveness of computed tomography-guided high-level percutaneous selective cervical cordotomy (CT-guided HPSCC). CT-guided percutaneous procedures were performed in fifty-nine patients between the years 2004- 2013 for cancer pain. Forty-eight patients with cancer-related body pain were treated with CT-guided HPSCC was evaluated retrospectively. CT-guided HPSCC was performed in 33 male and 15 female patients. The mean age was 49.93 years. The distance between skin-dura, anteroposterior diameter and mediolateral diameter was measured as 40 to 71.1 mm, 8 to 88 mm and 8 to 99 mm respectively. The mean postoperative Karnofsky Performance Score (KPS) was 95. Mean preoperative Visual Analog Scale (VAS) score was 9.6, and 3.6 on postoperative day 1. The 6 < sup > th < /sup > month follow-up VAS score was 6.8. Preoperative total sleeping hours in a 24-hour period were 5.5 hours, which increased in the immediate postoperative period to 8.5 hours. The most common pathology treated was bronchogenic carcinoma. Six of the procedures were bilateral and there were no permanent complication due to the procedure. CT-guided HPSCC is still very effective, cheap and repetitive procedure for cancer pain. The procedure should be performed by experienced surgeons and although there is a hegemony of opioids, the number of surgeons that perform the procedure must be increased.

Role of percutaneous cervical cordotomy in cancer pain management

Pain control in cancer patients reduces suffering and improves the quality of life. The classic World Health Organization (WHO) analgesic ladder may be effective in controlling cancer pain in 80–90% of patients. In the UK, current application of the principles embodied in the WHO ladder follows a modified algorithm by which interventional techniques should be considered as adjuvant therapy alongside all steps of the analgesic ladder. Recent UK experience suggests that, despite optimization of systemic analgesia, 11% patients in a hospice setting were considered for interventional therapy. The scope of advanced pain management techniques in adult palliative care is contained within the Specialised Services National Definition Set and the full range of interventions has been reviewed elsewhere. This article describes the technique and application of percutaneous cervical cordotomy (PCC) in the management of intractable unilateral cancer pain. Experience of the neurological deficit resulting from tuberculous lesions of the spinal cord caused Spiller to conclude that pain could be relieved by cutting the pain pathway in the spinal cord, leading to the first open surgical cordotomy in 1905. Reports of open cordotomy via thoracic and cervical laminectomy continued until percutaneous techniques were described in the 1960s, initially using a radioactive needle and subsequently with radiofrequency (RF) thermocoagulation. A computed tomography (CT)guided technique has been described, but the vast majority of cordotomies performed in the UK are by percutaneous RF under fluoroscopic guidance.

Open Thoracic Cordotomy as a Treatment Option for Severe, Debilitating Pain

The treatment of patients with debilitating lower extremity or medically refractory quadrant pain presents a challenge for management. Contemporary neuromodulatory therapies may not be affordable or practical, especially in patients with limited life expectancy or from countries with limited resources. We present a small retrospective series to evaluate the role of open thoracic cordotomy as a practice option in the treatment of patients with severe, unilateral, medically refractory pain of the lower abdominal quadrant, hip, or leg. Technical aspects of the procedure, anatomic pathways within the spinal cord, and intraoperative maneuvers are described. The medical records of 9 patients (7 men, 2 women; median age, 57 years) treated between 1998 and 2010 were reviewed. Each patient underwent open thoracic cordotomy after 1998 for severe lower quadrant or lower extremity pain refractory to multiple other treatment modalities. The indications for surgery included cancer-related pain (4 of 9), postherpetic neuralgia (2 of 9), post-spinal cord injury pain (2 of 9), and multiple sclerosis (1 of 9). Six of nine patients reported improvement in their postoperative level of pain after a median follow-up of 31 weeks. Complications included ipsilateral lower extremity weakness, urinary incontinence, and the development of new postcordotomy pain. A higher incidence of complications, including ipsilateral motor weakness, was observed in this series than with previous reports of percutaneous cervical cordotomy (PCC). Although open thoracic cordotomy may be cautiously recommended as a treatment option in certain settings, this procedure should be viewed only as a second-line treatment option in settings where the technology and expertise to perform PCC are available.

Percutaneous Cervical Cordotomy for the Management of Pain from Cancer: A Prospective Review of 45 Cases

Percutaneous cervical cordotomy (PCC) is a well recognized but infrequently performed procedure for the relief of unilateral intractable pain from malignancy. There is a paucity of data regarding efficacy and safety of PCC. The study's objectives were to demonstrate the efficacy and safety of PCC in cancer pain. The study was a prospective review of 45 cases undergoing PCC at a tertiary referral center over a three-year period. All patients were suffering from severe, refractory unilateral pain secondary to malignancy with poor pain relief or intolerable side effects of conventional analgesics including opioids and adjuvants. Variables recorded preprocedure, at 2 days, and at 28 days postprocedure were numerical rating scale for maximum and average pain, oral morphine equivalent dose, and global impression of change. Adverse events and survival postprocedure were recorded. Prospective data was obtained in 45 patients. Survival postprocedure ranged from 7 days to 33 months. There was a significant reduction from baseline in pain scores at 2 days and at 28 days postprocedure. Thirty-two patients experienced significant pain relief--average numerical rating scale (NRS) of zero--on day 2. Improvement in pain scores was sustained at 28 days. There were no serious adverse events observed such as respiratory failure. PCC is a safe and highly effective procedure to treat intractable unilateral cancer pain. It offers significant advantages over other pain control methods. Patient selection and attention to detail is paramount for a successful outcome.

108 Raising the awareness of percutaneous cervical cordotomy as an aid to pain relief for patients with unilateral chest pain caused by thoracic malignancy

108 Raising the awareness of percutaneous cervical cordotomy as an aid to pain relief for patients with unilateral chest pain caused by thoracic malignancy