Interruption of the spinothalmic tracts is the most frequent neurosurgical procedure in the treatment of intractable pain. Since the level of analgesic gradually may fall, this procedure is most effective in treating intractable pain associated with malignant diseases. Although methods have been developed to interrupt these pain pathways percutaneously, there is still a place for the open operation in the neurosurgical armamentarium. It has been our experience that high cervical cordotomy patients have more complete and longer lasting levels of analgesia. Therefore, it has been our policy to do unilateral cordotomies at the C1–2 level. When a bilateral cordotomy is indicated, it is either done at a lower level (high thoracic) or in stages. Simultaneous bilateral high cervical cordotomy may result in respiratory difficulties and/or postural hypotension. In doing a bilateral cordotomy, the second lesion is placed eight mm. aboye or below the first incision.
KeywordsPostural Hypotension Pain Pathway Intractable Pain Respiratory Difficulty Anterior Spinal Artery
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