The dying art of percutaneous cordotomy in canada

摘要

CORDOTOMY INVOLVES THE SURGICAL ABLATION of the spinothalamic tract within the spinal cord to treat pain. In 1912, Spiller and Martin described an 'open' cordotomy where the spinal cord was directly visualized through a thoracic laminectomy. In 1963, Mullan introduced a less invasive percutaneous technique using a needle inserted between the first and second vertebra under fluoroscopic guidance. Additional advances in intraoperative imaging and electrophysiological confirmation of the target improved the outcomes and reduced complications. In the 1970s, cordotomy was a common neurosurgical procedure for chronic pain. It became clear, however, that the effects could wear off over time and could occasionally cause a new deafferentation neuropathic pain. Cordotomy was therefore usually reserved for patients with nociceptive pain of malignant origin, because the patients' reduced lifespan would reduce the likelihood of wearing off or neuropathic pain.