Percutaneous Computed Tomography-guided Radiofrequency Ablation of Upper Spinal Cord Pain Pathways for Cancer-Related Pain

Abstract Objective: The author presents data to support the continued need for ablative procedures, particularly cordotomy, in the management of cancer-related pain. Methods: Fifty-one patients with cancer-related body or face pain were treated with computed tomography-guided radiofrequency ablation of the spinothalamic tract or trigeminal tract nucleus in the upper cervical region of the spinal cord. Forty-one patients underwent a unilateral cervical cordotomy, and 10 patients underwent a trigeminal tractotomy–nucleotomy. Three methods to assess patient pain were used: degree of pain relief, Visual Analog Scale, and total sleeping hours. The Karnofsky scale was used to measure the patient's level of function pre- and postprocedure. Results: After surgical intervention, patients reported initial and 6-months follow-up pain relief as 98 and 80%, respectively. Conclusion: Computed tomography-guided ablation of the upper cervical spinal cord is a safe and effective procedure to treat cancer pain involving the body or face. There remains a need for ablative procedures, in particular cordotomy, in the management of cancer-related pain.

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Position of Spinothalamic Tract Axons in Upper Cervical Spinal Cord of Monkeys

Journal of Neurophysiology ◽

10.1152/jn.2000.84.3.1180 ◽

2000 ◽

Vol 84 (3) ◽

pp. 1180-1185 ◽

Cited By ~ 25

Author(s):

Xijing Zhang ◽

Christopher N. Honda ◽

Glenn J. Giesler

Keyword(s):

Spinal Cord ◽

Dorsal Horn ◽

Dynamic Range ◽

Cervical Spinal Cord ◽

High Threshold ◽

Spinothalamic Tract ◽

Antidromic Activation ◽

Lateral Funiculus ◽

Upper Cervical ◽

Low Threshold

Percutaneous upper cervical cordotomy continues to be performed on patients suffering from several types of severe chronic pain. It is believed that the operation is effective because it cuts the spinothalamic tract (STT), a primary pathway carrying nociceptive information from the spinal cord to the brain in humans. In recent years, there has been controversy regarding the location of STT axons within the spinal cord. The aim of this study was to determine the locations of STT axons within the spinal cord white matter of C2 segment in monkeys using methods of antidromic activation. Twenty lumbar STT cells were isolated. Eleven were classified as wide dynamic range neurons, six as high-threshold cells, and three as low-threshold cells. Eleven STT neurons were recorded in the deep dorsal horn and nine in superficial dorsal horn. The axons of the examined neurons were located at antidromic low-threshold points (<30 μA) within the contralateral lateral funiculus of C2. All low-threshold points were located ventral to the denticulate ligament, within the lateral half of the ventral lateral funiculus (VLF). None were found in the dorsal half of the lateral funiculus. The present findings support our previous suggestion that STT axons migrate ventrally as they ascend the length of the spinal cord. Also, the present findings indicate that surgical cordotomies that interrupt the VLF in C2 likely disrupt the entire lumbar STT.

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Intramedullary mature teratoma of the cervical spinal cord at C1–2 associated with occult spinal dysraphism in an adult

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.6.12 ◽

2007 ◽

Vol 6 (6) ◽

pp. 579-584 ◽

Cited By ~ 31

Author(s):

Raafat Makary ◽

David Wolfson ◽

Victor Dasilva ◽

Amir Mohammadi ◽

Sania Shuja

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Spinal Dysraphism ◽

Treatment Options ◽

Mature Teratoma ◽

Postoperative Outcome ◽

Complete Removal ◽

Cervical Region ◽

Upper Cervical ◽

Spinal Malformations

✓There is a well-recognized association between dysontogenetic tumors of the spinal cord (including teratomas and enterogenous cysts) and dysraphic congenital spinal malformations. The authors present a case of an adult with an intramedullary mature teratoma (IMMT) at the level of C1–2 of the cord associated with dysraphic congenital spinal malformations. Intramedullary mature teratomas of the cervical region of the spinal cord are very rare in adults; only four such lesions have been reported, two of which involved upper cervical segments. Despite the potentially critical location of the tumor, monitored microsurgery resulted in complete removal of the tumor with an intact surrounding capsule, associated fibrous tract, and ellipse of skin with a central dimple. There was an excellent postoperative neurological outcome. The clinical features, imaging studies, treatment options, postoperative outcome, and plausible pathological correlations of IMMTs are discussed.

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