Skip to main content

Advertisement

SpringerLink
Log in

Open thoracic cordotomy for intractable cancer pain: a how I do it

  • How I Do it
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Some cancers of the lower extremity involve nerves and plexuses and can produce extreme drug-resistant noceptive pain. In these cases, open thoracic cordotomy can be proposed.

Method

This procedure involves disruption of the spinothalamic tract, which sustains nociceptive pathways. After placement in the prone position, selection of the side to be operated on (contralateral to the pain), and dura exposure, microsurgery is used to section the anterolateral spinal cord quadrant previously exposed by gently pulling on the dentate ligament.

Conclusion

Open thoracic cordotomy is a moderate invasive, safe, and effective option for the management of drug-resistant unilateral lower extremity cancer pain in well-selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

We support data sharing within the restrictions of the ethical approval permissions. Reasonable requests can be made to the corresponding author.

References

  1. Berger A, Hochberg U, Zegerman A, Tellem R, Strauss I (2019) Neurosurgical ablative procedures for intractable cancer pain. J Neurosurg 133(1):144–151

  2. Cowie RA, Hitchcock ER (1982) The late results of antero-lateral cordotomy for pain relief. Acta Neurochir (Wien) 64(1–2):39–50

    Article  CAS  PubMed  Google Scholar 

  3. Jones B, Finlay I, Ray A, Simpson B (2003) Is there still a role for open cordotomy in cancer pain management? J Pain Symptom Manage 25(2):179–184

    Article  CAS  PubMed  Google Scholar 

  4. Konrad P (2014) Dorsal root entry zone lesion, midline myelotomy and anterolateral cordotomy. Neurosurg Clin N Am 25(4):699–722

    Article  PubMed  Google Scholar 

  5. Romanelli P, Esposito V (2004) The functional anatomy of neuropathic pain. Neurosurg Clin N Am 15(3):257–268

    Article  PubMed  Google Scholar 

  6. Steel D, Kirkman MA, Thompson DNP, Aquilina K (2017) Open thoracic anterolateral cordotomy for pain relief in children: report of 2 cases. J Neurosurg Pediatr 20(3):278–283

    Article  PubMed  Google Scholar 

  7. Tomycz L, Forbes J, Ladner T, Kahn E, Maris A, Neimat J, Konrad P (2014) Open thoracic cordotomy as a treatment option for severe, debilitating pain. J Neurol Surg A Cent Eur Neurosurg 75(2):126–132

    PubMed  Google Scholar 

  8. Vedantam A, Bruera E, Hess KR, Dougherty PM, Viswanathan A (2019) Somatotopy and organization of spinothalamic tracts in the human cervical spinal cord. Neurosurgery 84(6):E311–E317

    Article  PubMed  Google Scholar 

  9. White JC, Sweet WH, Hawkins R, Nilges RG (1950) Anterolateral cordotomy: results, complications and causes of failure. Brain 73(3):346–367

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Thanks to Jasmine Taylor for her English proofreading and help with the video.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Service de Neurochirurgie, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France

    Arthur Leclerc, Camille Di Palma & Evelyne Emery

  2. UNICAEN, ISTCT/CERVOxy Group, UMR6030, GIP CYCERON, Normandy University, Caen, France

    Arthur Leclerc

  3. INSERM, UMR-S U1237, GIP Cyceron, Physiopathology and Imaging of Neurological Disorders (PhIND), 14000, Caen, France

    Evelyne Emery

Authors
  1. Arthur Leclerc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Camille Di Palma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evelyne Emery
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arthur Leclerc.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Ethics Committee of Caen University Hospital (Caen, France) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from the patient included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 155863 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leclerc, A., Di Palma, C. & Emery, E. Open thoracic cordotomy for intractable cancer pain: a how I do it. Acta Neurochir 165, 2197–2200 (2023). https://doi.org/10.1007/s00701-023-05696-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-023-05696-2

Keywords

Search

Navigation