Cordotomy and Alternatives

Cordotomy: Definition

Cordotomy is a surgical procedure performed on patients suffering from severe pain due to cancer and other incurable diseases.

The purpose is to achieve elimination of pain and the perception of temperature. The procedure renders inoperative selected pain-conducting zones in the spinal cord.

This procedure is usually performed under local anesthesia using a fluoroscope.

Open cordotomy, which requires a laminectomy, is often risky for patients with poor medical histories or deteriorated conditions, but may be required if percutaneous* cordotomy either isn’t possible or an attempt has been unsuccessful.

[* percutaneous = administered or absorbed through the skin, as an injection]


Alternatives

A number of alternative surgical procedures have evolved in the 20th century, including the following...

Commissural Myelotomy

Commissural myelotomy is one alternative to cordotomy.

The term, commissural, comes from the term, commissure, which means: a connecting band of nerve fiber, esp. one joining the right and left sides of the brain or spinal cord.

It is a surgical procedure in which a multi-level laminectomy is performed to expose the appropriate lumbar or sacral segments of the spinal cord. With the help of an operating microscope, a vertical incision is made and the spinal cord is divided.

Commissural myelotomy interrupts pain-conducting pathways that run through the center of the spinal cord. Bilateral and midline pelvic or perineal pain are indications for use of this technique. Potential post-operatives issues may be sphincter or motor dysfunction.


Punctate Midline Myelotomy

Punctate Midline Myelotomy is a minimally invasive procedure used for the treatment of pelvic and visceral cancer pain. It is a recent and promising development in the treatment of this type of pain.

While surgical treatment of intractable visceral pain has always been a challenge, a recent discovery of a specific visceral pain pathway has been a promising discovery.

Recently, Dr. Elie D. Al-Chaer and his colleagues discovered a new pathway in the spinal cord specific to 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. It is a neuroablative operation with the intent of interrupting the midline of the dorsal column. It has demonstrated efficacy in the treatment of otherwise intractable abdominal and pelvic cancer pain.

Due to its effectiveness, simplicity, safety, it may become the treatment of choice for intractable visceral pain.


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