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Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer.

T M Shepherd1,2, M J Hoch3, B A Cohen3

  • 1From the Department of Radiology (T.M.S., M.J.H., B.A.C., M.T.B., E.F.) timothy.shepherd@nyumc.org.

AJNR. American Journal of Neuroradiology
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Summary

Palliative cervical cordotomy offers a safe and effective treatment for intractable unilateral extremity pain in advanced cancer patients. This study details the procedure and its associated MRI changes.

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Area of Science:

  • Neurosurgery
  • Pain Management
  • Radiology

Background:

  • Palliative cervical cordotomy is a rare procedure targeting the lateral spinothalamic tract at C1-2.
  • It aims to alleviate severe, intractable unilateral extremity pain, often in end-stage cancer patients.

Observation:

  • This report reviews indications, techniques, risks, and benefits of cervical cordotomy.
  • It details the treatment of 3 patients using CT-guided C1-2 cordotomy.
  • The study presents the first characterization of spinal cord diffusion MRI changes post-cordotomy.

Findings:

  • CT-guided percutaneous radiofrequency ablation of the C1-2 spinothalamic tract is a viable option for pain management.
  • Successful cordotomy demonstrated characteristic diffusion MRI changes in the spinal cord.

Implications:

  • Cervical cordotomy can be a safe and advantageous palliative option for specific patients.
  • Understanding MRI changes aids in assessing procedure success and patient outcomes.