5.4.1.3 Anterolateral Cordotomy (Spinal Tractotomy)
Anterolateral cordotomy is an ablative procedure aimed at the pain-conducting
tracts in the anterolateral quadrant of the spinal cord. Cordotomy provides the
selective loss of pain and temperature perception several segments below and
contralateral to the segment at which the lesion is placed. Anterolateral
cordotomy is effective for unilateral, mainly somatic pain below the
midcervical dermatomes (Ischia, Ischia, Luzzani, et al., 1985; Lahuerta,
Lipton, and Wells, 1985b). For visceral pain or bilateral pain, bilateral
cordotomies may be required (Amano, Kawamura, Tanikawa, et al., 1991). Most
cordotomies are currently done with the patient under local anesthesia by the
percutaneous route under fluoroscopic guidance, and the lesion is created by
radiofrequency. The percutaneous approach avoids risks of open operation and
anesthesia in patients in poor medical condition.
Open cordotomies require a laminectomy and are most frequently performed at the
low cervical or upper thoracic spine. Open cordotomy may benefit patients in
whom a percutaneous procedure has failed, those who cannot cooperate because of
severe pain or confusion, those at risk for respiratory compromise, or those
with bilateral pain in whom a bilateral, high cervical cordotomy carries
additional risk of necrologic impairment. Potential complications include
unmasking of dysesthetic pain; bladder, bowel, and sexual dysfunction; ataxia;
paresis; and sleep apnea (Lahuerta, Lipton, and Wells, 1985a; Tasker, 1988).
Related Chunks
Radiation Therapy
Other Therapeutic Applications
Peripheral Neurectomy
Dorsal Rhizotomy
Commissural Myelotomy
Hypophysectomy
Neuroaugmentation
Surgical Management of Pain due to Primary or Metastatic Tumor
Index