Cordotomy

Cordotomy
Cordotomy
Intervention
ICD-9-CM 03.2
MeSH D002818

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 diseases for which there is currently no cure. Anterolateral cordotomy is effective for relieving unilateral, somatic pain while bilateral cordotomies may be required for visceral or bilateral pain.

Cordotomy is usually done percutaneously with fluoroscopic guidance while the patient is under local anesthesia. Open cordotomy, which requires a laminectomy, is often risky for patients with poor medical conditions, but may be required if percutaneous cordotomy is not feasible or an attempt has failed.

Cordotomy is now used exclusively for pain due to cancer where treatment to level 3 of the World Health Organisation pain ladder has proved ineffective. Cordotomy is especially indicated for pain due to asbestos-related cancers such as pleural and peritoneal mesothelioma.

Although cordotomy is effective in the relief of pain, the effect is usually temporary. Dysesthesia develops after most cordotomies.[1]

A number of alternative surgical procedures have evolved in the 20th century; these include:

Commissural myelotomy, with limited rostro-caudal range; it produces bilateral analgesia (Armour 1927; Hitchcock 1970; 74).

Limited midline myelotomy for the treatment of pelvic visceral cancer pain (Gildenberg and Hirshberg, 1984).

Recently[when?], doctors at the University of Arkansas for Medical Sciences discovered a new pathway in the spinal cord relatively specific for visceral pain - the pain that originates from visceral organs such as the colon, bladder and 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 the 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.[citation needed]

External links

References

  1. ^ Mann, Michael. "Somesthesia - Central Mechanisms". The Nervous System in Action. http://www.unmc.edu/physiology/Mann/mann6.html. Retrieved 30 May 2011. 



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Look at other dictionaries:

  • cordotomy — 1. Any operation on the spinal cord. 2. Division of tracts of the spinal cord, which may be performed percutaneously (stereotactic c.) or after laminectomy (open c.) by various techniques such as incision or radio frequency …   Medical dictionary

  • cordotomy — n. a surgical procedure for the relief of severe and persistent pain in the pelvis or lower limbs. The nerve fibres that transmit the sensation of pain to consciousness pass up the spinal cord in special tracts (the spinothalamic tracts). In… …   The new mediacal dictionary

  • cordotomy — /kawr dot euh mee/, n., pl. cordotomies. the surgical severance of certain nerve fibers of the spinal cord to alleviate intractable pain. Also, chordotomy. [CORD + O + TOMY] * * * …   Universalium

  • cordotomy — noun The surgical procedure for selectively disabling pain conducting nerve paths in the spinal cord to relieve chronic pain …   Wiktionary

  • cordotomy — n. surgical procedure in which certain nerves of the spinal cord are severed in order to relieve incurable pain (Medicine) …   English contemporary dictionary

  • cordotomy — variant of chordotomy …   Useful english dictionary

  • open cordotomy — cordotomy (def. 2) done through an open incision; now largely replaced by percutaneous cordotomy …   Medical dictionary

  • percutaneous cordotomy — cordotomy (def. 2) performed using percutaneous electrodes guided radiographically with stereotactic techniques; approaches used include lateral high cervical, posterior high cervical, and anterior low cervical …   Medical dictionary

  • Хордотомия (Cordotomy) — хирургическое вмешательство, позволяющее уменьшить сильную и упорную боль в области таза или нижних конечностей. Нервные волокна, по которым болевые сигналы поступают в мозг, проходят в спинном мозге по специальным проводящим путям… …   Медицинские термины

  • ХОРДОТОМИЯ — (cordotomy) хирургическое вмешательство, позволяющее уменьшить сильную и упорную боль в области таза или нижних конечностей. Нервные волокна, по которым болевые сигналы поступают в мозг, проходят в спинном мозге по специальным проводящим путям… …   Толковый словарь по медицине

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