Spinal Neuroablation for Cancer Pain

  • William S. RosenbergEmail author
  • Parag G. Patil
  • Ahmed M. Raslan


In cases of refractory cancer pain, disruption of the pain processing mechanisms of the nervous system can be helpful, an approach that may be more useful as the risks of opioid analgesia becomes more evident. There are several targets in the spinal cord that are available for an ablative procedure for pain control. Cordotomy, or interruption of the lateral spinothalamic tract, can be effective in controlling unilateral pain below the C4 dermatome. Myelotomy disconnects a dorsal midline polysynaptic visceral pain pathway and can reduce visceral, retroperitoneal, pelvic, or sacral pain. Along with other targets for neuroablation, these are important components of a successful approach to controlling cancer pain.


Neuroablation Cordotomy Myelotomy DREZ Nucleotractotomy Trigeminal spinal nucleus Cancer pain Palliation 


  1. 1.
    Spiller WG, Martin E. 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. 1912;LVIII(20):1489–90.CrossRefGoogle Scholar
  2. 2.
    Kanpolat Y. Percutaneous cordotomy, tractotomy, and midline myelotomy: minimally invasive stereotactic pain procedures. In: Fisher W, Burchiel K, editors. Seminars in neurosurgery: pain management for the neurosurgeon, vol. 2. New York: Thieme Medical Publishers Inc.; 2005. p. 203–19.Google Scholar
  3. 3.
    Walker A. The spinothalamic tract in man. Arch Neurol Psychiatr. 1940;43(2):284–98.CrossRefGoogle Scholar
  4. 4.
    Hodge C, Christensen M. Anterolateral cordotomy. In: Burchiel K, editor. Surgical management of pain. Stuttgart/New York: Thieme Medical Publishers Inc; 2002. p. 732–44.Google Scholar
  5. 5.
    Mullan S, Harper PV, Hekmatpanah J, Torres H, Dobbin G. Percutaneous interruption of spinal-pain tracts by means of a Strontium90 needle. J Neurosurg. 1963;20:931–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Rosomoff HL, Brown CJ, Sheptak P. Percutaneous radiofrequency cervical cordotomy: technique. J Neurosurg. 1965;23(6):639–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Kanpolat Y, Akyar S, Caglar S. Diametral measurements of the upper spinal cord for stereotactic pain procedures: experimental and clinical study. Surg Neurol. 1995;43(5):478–82. discussion 482–473PubMedCrossRefGoogle Scholar
  8. 8.
    Kanpolat Y, Akyar S, Caglar S, Unlu A, Bilgic S. CT-guided percutaneous selective cordotomy. Acta Neurochir. 1993;123(1–2):92–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Kanpolat Y, Savas A, Batay F, Sinav A. Computed tomography-guided trigeminal tractotomy-nucleotomy in the management of vagoglossopharyngeal and geniculate neuralgias. Neurosurgery. 1998;43(3):484–9. discussion 490PubMedCrossRefGoogle Scholar
  10. 10.
    Raslan AM. Percutaneous computed tomography-guided transdiscal low cervical cordotomy for cancer pain as a method to avoid sleep apnea. Stereotact Funct Neurosurg. 2005;83(4):159–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Kanpolat Y, Savas A, Akyar S, Cosman E. Percutaneous computed tomography-guided spinal destructive procedures for pain control. Neurosurg Q. 2004;14:229–38.CrossRefGoogle Scholar
  12. 12.
    Fonoff ET, de Oliveira YS, Lopez WO, Alho EJ, Lara NA, Teixeira MJ. Endoscopic-guided percutaneous radiofrequency cordotomy. J Neurosurg. 2010;113(3):524–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Collins KL, Patil PG. Flat-panel fluoroscopy O-arm-guided percutaneous radiofrequency cordotomy: a new technique for the treatment of unilateral cancer pain. Neurosurgery. 2013;72(1 Suppl Operative):27–34. discussion 34PubMedGoogle Scholar
  14. 14.
    Raslan AM, Cetas JS, McCartney S, Burchiel KJ. Destructive procedures for control of cancer pain: the case for cordotomy. J Neurosurg. 2011;114(1):155–70.PubMedCrossRefGoogle Scholar
  15. 15.
    France BD, Lewis RA, Sharma ML, Poolman M. Cordotomy in mesothelioma-related pain: a systematic review. BMJ Support Palliat Care. 2014;4(1):19–29.PubMedCrossRefGoogle Scholar
  16. 16.
    Taren JA, Kahn EA. Anatomic pathways related to pain in face and neck. J Neurosurg. 1962;19:116–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Sjogvist O. Studies on pain conduction in the trigeminal nerve: a contribution to the surgical treatment of facial pain. JAMA. 1940;115(5):408.Google Scholar
  18. 18.
    Crue BL, Carregal EJA, Felsoory A. Percutaneous stereotactic radiofrequency trigeminal Tractotomy with neurophysiological recordings. Stereotact Funct Neurosurg. 1972;34(6):389–97.CrossRefGoogle Scholar
  19. 19.
    Hitchcock E. Stereotactic trigeminal tractotomy. Ann Clin Res. 1970;2(2):131–5.PubMedGoogle Scholar
  20. 20.
    Kanpolat Y, Deda H, Akyar S, Caglar S, Bilgic S. CT-guided trigeminal tractotomy. Acta Neurochir. 1989;100(3–4):112–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Thompson EM, Burchiel KJ, Raslan AM. Percutaneous trigeminal tractotomy-nucleotomy with use of intraoperative computed tomography and general anesthesia: report of 2 cases. Neurosurg Focus. 2013;35(3):E5.PubMedCrossRefGoogle Scholar
  22. 22.
    Bernard EJ Jr, Nashold BS Jr, Caputi F, Moossy JJ. Nucleus caudalis DREZ lesions for facial pain. Br J Neurosurg. 1987;1(1):81–91.PubMedCrossRefGoogle Scholar
  23. 23.
    Hitchcock E. Stereotactic cervical myelotomy. J Neurol Neurosurg Psychiatry. 1970;33(2):224–30.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Nauta HJ, Hewitt E, Westlund KN, Willis WD Jr. Surgical interruption of a midline dorsal column visceral pain pathway. Case report and review of the literature. J Neurosurg. 1997;86(3):538–42.PubMedCrossRefGoogle Scholar
  25. 25.
    Al-Chaer ED, Lawand NB, Westlund KN, Willis WD. Pelvic visceral input into the nucleus gracilis is largely mediated by the postsynaptic dorsal column pathway. J Neurophysiol. 1996;76(4):2675–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Al-Chaer ED, Lawand NB, Westlund KN, Willis WD. Visceral nociceptive input into the ventral posterolateral nucleus of the thalamus: a new function for the dorsal column pathway. J Neurophysiol. 1996;76(4):2661–74.PubMedCrossRefGoogle Scholar
  27. 27.
    Kanpolat Y, Atalag M, Deda H, Siva A. CT guided extralemniscal myelotomy. Acta Neurochir. 1988;91(3–4):151–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Schvarcz JR. Stereotactic extralemniscal myelotomy. J Neurol Neurosurg Psychiatry. 1976;39(1):53–7.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.CrossRefGoogle Scholar
  30. 30.
    Sindou M, Mertens P. Surgery in the dorsal root entry zone for pain. In: Fisher W, Burchiel K, editors. Seminars in neurosurgery: pain management for the neurosurgeon, vol. 2. New York: Thieme medical publishers Inc.; 2005. p. 221–32.Google Scholar
  31. 31.
    Dreval ON. Ultrasonic DREZ-operations for treatment of pain due to brachial plexus avulsion. Acta Neurochir. 1993;122(1–2):76–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Powers SK, Adams JE, Edwards MS, Boggan JE, Hosobuchi Y. Pain relief from dorsal root entry zone lesions made with argon and carbon dioxide microsurgical lasers. J Neurosurg. 1984;61(5):841–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Wall P. Presynaptic control of impulses at the first central synapse in the cutaneous pathway. In: Eccles J, Schade J, editors. Physiology of spinal neurons. Amsterdam: Elsevier; 1964. p. 92–118.Google Scholar
  34. 34.
    Guenot M, Bullier J, Sindou M. Clinical and electrophysiological expression of deafferentation pain alleviated by dorsal root entry zone lesions in rats. J Neurosurg. 2002;97(6):1402–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Emery E, Blondet E, Mertens P, Sindou M. Microsurgical DREZotomy for pain due to brachial plexus avulsion: long-term results in a series of 37 patients. Stereotact Funct Neurosurg. 1997;68(1–4 Pt 1):155–160.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • William S. Rosenberg
    • 1
    Email author
  • Parag G. Patil
    • 2
  • Ahmed M. Raslan
    • 3
    • 4
  1. 1.Center for the Relief of PainKansas CityUSA
  2. 2.University of Michigan Medical CenterAnn ArborUSA
  3. 3.Oregon Health & Science University, Department of NeurosurgeryPortlandUSA
  4. 4.Portland VA Medical CenterNeurological SurgeryPortlandUSA

Personalised recommendations