Summary
Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6–132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a “last resort”.
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References
Abbott KH, Retter RH (1958) Antero-lateral cordotomy for intractable pain following unsuccessful disc surgery: Review of 14 cases. Bull Los Angeles Neurol Soc 23: 112–118
Babtchine IS (1936) Les résultats immédiats et lointains de la cordotomie. J Chir Paris 47: 26–39
Bowsher D (1957) Termination of the central pain pathway in man: The conscious appreciation of pain. Brain 80: 606–622
Cioni B, D'Annunzio V, Meglio M (1981) Percutaneous cordotomy in cancer pain: Its value and complications. Acta Neurochir (Wien) 57: 9310 (Proc of the 29th Annual Meeting of the Soc Ital di Neurochir, Roma, 20–22 Nov 1980)
Collins WF (1970) According to White JC and Sweet WH in: Bonica JJ (ed) Advances in pain research and therapy, Vol 3. Raven Press, New York, pp. 911–919
Cowie RA, Hitchcock ER (1982) The late results of anterolateral cordotomy for pain relief. Acta Neurochir (Wien) 64: 39–50
Dennis StG, Melzack R (1977) Pain-signalling systems in the dorsal and ventral spinal cord. Pain 4/2: 97–132
Diemath HE, Heppner F, Walker AE (1961) Antero-lateral cordotomy for relief of pain. Postgrad Med 29: 485–495
Falconer MA (1953) Surgical treatment of intractable phantomlimb-pain. Br Med J 1: 299–304
Falconer MA (1966) Relief of phantom pain by cordotomy. In: Knighton RS, Dumke PR (eds) Pain. Little, Brown, Boston p 273
Foerster O (1913) Vorderseitenstrangdurchschneidung im Rückenmark zur Beseitigung von Schmerzen. Berliner Klin Wschr 50: 1499–1500
Frankel SA, Prokop JD (1961) Value of cordotomy for the relief of pain. N Engl J Med 264: 971–974
French LA, Peyton WT (1948) Ipsilateral sensory loss following cordotomy. J Neurosurg 5: 403–404
Grant FC, Wood FA (1958) Experiences with cordotomy. Clin Neurosurg 5: 38–65
Jack TM, Lloyd JW (1983) Long-term efficacy of surgical cordotomy in intractable non-malignant pain. Ann Coll Surg Engl 97–102
Kahn EA, Peet MM (1948) The technique of antero-lateral cordotomy. J Neurosurg 5: 276–283
Kuhner A (1976) La cordotomie cervicale percutanée. Neuro-Chirurgie 22: 261–280
McKissock W (1961) Spinothalamic chordotomy. Second International Congress of Neurological Surgery, Washington DC (abstract no S17): D31–D34
Mansuy L, Sindou M, Fischer G, Brunon J (1976) La cordotomie spinothalamique dans les douleurs cancéreuses. Résultats d'une série de 124 malades opérés par abord direct postérieur. Neuro-Chirurgie 22/5: 437–444
Matossi l'Orsa R, Miegge C, Carmignani F, Bona C, Debernardi F, Prioglio S, Borello G, Delpero M, Bellero L (1980) Cordotomia spinothalamica nel trattamento del dolore. Minerva Anestesiol 46: 89–102
Mattmann E (1972) Die perkutane hochzervikale Chordotomie zur symptomatischen Schmerzbehandlung. Schweiz Arch Neurol Neurochir Psychiatry 111/2: 341–352
Meglio M, Cioni B (1981) The role of percutaneous cordotomy in the treatment of chronic cancer pain. Acta Neurochir (Wien) 59: 111–121
Miles J (1977) In: Lipton S (ed) Persistent pain: Modern methods of treatment. Academic Press, London 1: 131–133
Mullan S, Harper PV, Hekmatpanah J, Torres H, Dobbin G (1963) Percutaneous interruption of spinal tracts by means of a strontium-90 needle. J Neurosurg 20: 931–939
Nathan PW (1963) Results of anterolateral cordotomy for pain in cancer. J Neurosurg Psychiatry 26: 353–362
Nathan PW, Smith MC (1979) Clinico-anatomical correlation in anterolateral cordotomy. In: Bonica JJ, Liebeskind JC, Albe-Fessard DG (eds) Advances in pain research and therapy 3. Raven Press, New York, p. 921
O'Connell JEA (1969) Anterolateral cordotomy for intractable pain in carcinoma of the rectum. Proc R Soc Med 62: 1223–1225
Ogle WS, French LA, Peyton WT (1956) Experiences with high cervical cordotomy. J Neurosurg 13: 81–87
Olivecrona H (1947) The surgery of pain. Acta Psych Scand [Suppl] 46: 268–280
Papo I (1979) Open cordotomy in the treatment of cancer pain. In: Advances in pain research and therapy, Vol. 2. Raven Press, New York, pp 449–452
Perneczky A, Sunder-Plassmann M (1975) Anterolateral cordotomy in cases of phantom limb pain. In: Penzholz H, Brock M, Hamer J, Klinger M, Spoerri I (eds) Advances in neurosurgery 3, Springer, Berlin Heidelberg New York, pp 170–173
Piscol K (1975) Open spinal surgery for (intractable) pain. In: Advances in neurosurgery, Vol 3. Springer, Berlin Heidelberg New York, pp 157–169
Porter RW, Hohmann GW, Bors E, French JD (1966) Cordotomy for pain following cauda equina injury. Arch Surg 92: 765–770
Probst Ch (1983) Neurochirurgische Möglichkeiten beim Karzinomschmerz. Praxis 72/6: 171–176
Probst Ch (1989) Neurochirurgische Schmerzbehandlung. In: Kaganas G, Müller W, WagenhÄuser FJ (Hrsg.) Fortbildungskurse für Rheumatologie. Schmerzbehandlung in der Rheumatologie, Bd 8. Karger, Basel, pp 159–174
Schwartz HG (1962) High cervical cordotomy. Technique and results. Clin Neurosurg 8: 282–293
Spiller WG, Martin E (1912) The treatment of persistent pain of organic origin in the lower part of the body by division of the anterolateral column of the spinal cord. JAMA 58: 1489–1490
Sweet WH (1976) Recent observations pertinent to improving anterolateral cordotomy. Clin Neurosurg 23: 80–95
Sweet WH, Poletti ChE (1989) Operations in the brain stem and spinal canal, with an appendix on open cordotomy. In: Wall PD, Melzack R (eds) Textbook of pain, second Ed. Ch Livingstone, pp 811–831
Tasker RR (1977) Open cordotomy. Progress in neurological surgery (8) Pain. Its neurosurgical management (Part II: Central procedures), pp 1–16
Thiébaut JB, Farco JM, Stoffels C, Laugner B, Müller A: Place actuelle des cordotomies percutanées et chirurgicales dans le traitement des douleurs des cancéreux. Soc de Neurochir de Langue FranÇaise, Réunion à Paris, 1–3 déc 1980 (abstracts)
Visalli F, Milza PG (1977) La nostra esperienza sulla cordotomia spinotalamica nelle gravi sindromi dolorose degli arti inferiori. Riv Neurol 47: 31–40
Von Brenner H, Pendl G (1966) Ipsilateraler Chordotomieeffekt — ein seltsamer Fall einer ungekreuzten Schmerzbahn. Wien Med Wschr 116: 1041–1042
Voris HC (1951) Ipsilateral sensory loss following chordotomy. Arch Neurol Psychiatry 65: 95–96
White JC, Sweet WH, Hawkins R, Nilges RG (1950) Anterolateral cordotomy. Results, complications and causes of failure. Brain 73: 346–367
White JC, Sweet WH (1955) Pain: its mechanisms and neurosurgical control. Ch C Thomas, Springfield, Illinois
White JC (1963) Anterolateral cordotomy: Its effectiveness in relieving pain of non malignant disease. Neurochirurgia 6: 83–102
White JC (1966) Cordotomy assessment of its effectiveness and suggestions for its improvement. Clin Neurosurg 13: 1–19
White JC, Sweet WH (1969) Pain and the neurosurgeon: A forty-year experience. Ch C Thomas, Springfield, Illinois
White JC, Sweet WH (1979) Anterolateral cordotomy: Open versus closed. Comparison of end results. In: Bonica JJ (ed) Advances in pain research and therapy, Vol 3. Raven Press, New York, pp 911–919
Yakovlev PI, Rakic P (1966) Patterns of decussation of bulbar pyramids and distribution of pyramidal tracts on two sides of the spinal cord. Trans Am Neurol Assoc 91, 366–370
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Probst, C. Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation. Acta neurochir 107, 30–36 (1990). https://doi.org/10.1007/BF01402609
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DOI: https://doi.org/10.1007/BF01402609