Cordotomy

Cordotomy
Intervention
ICD-9-CM	03.2
MeSH	D002818
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Cordotomy (or chordotomy) is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperature perception. This procedure is commonly performed on patients experiencing severe pain due to cancer or other incurable diseases. Anterolateral cordotomy is effective for relieving unilateral, somatic pain while bilateral cordotomies may be required for visceral or bilateral pain.

Cordotomy is performed as for patients with severe intractable pain, usually but not always due to cancer. Being irreversible and relatively invasive, corodotomy is used exclusively for pain where treatment to level 3 of the World Health Organization pain ladder (i.e., use of major opiates such as morphine) has proved inadequate. Cordotomy is especially indicated for pain due to asbestos-related cancers such as pleural and peritoneal mesothelioma.

Most cordotomies are now performed percutaneously with fluoroscopic or CT guidance while the patient is awake under local anesthesia. The spinothalamic tract is normally divided at the level C1-C2.

Open cordotomy, which requires a laminectomy (removal of part of one or more vertebrae), takes placer under general anaesthetic and has a longer recovery time and a higher risk of side-effects including permanent weakness. However, it is still sometimes used where percutaneous cordotomy is unfeasible, especially in children or other patients who are unable to co-operate. In open cordotomy, a thoracic approach is normally used so that the spinal cord tracts controlling the breathing muscles are not put at risk.

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