Cordotomy for Intractable Cancer Pain: A Historical and Technical Narrative Review with Modern Perspectives

Area of Science:

• Neurosurgery
• Pain Management
• Palliative Care

Background:

• Percutaneous cervical cordotomy (PCC) targets spinal cord pain pathways for unilateral cancer pain.
• PCC remains vital when pharmacologic and neuromodulatory therapies fail or are intolerable.
• Its utilization has decreased but it is a critical palliative intervention.

Purpose of the Study:

• To review the neuroanatomical basis, technical advancements, and clinical outcomes of PCC.
• To highlight PCC's role in managing refractory cancer pain.
• To discuss improvements in procedural safety and patient selection.

Main Methods:

• Review of neuroanatomical underpinnings and technical evolution of PCC.
• Analysis of contemporary clinical outcomes from modern series.
• Discussion of adaptations like deep sedation with neurophysiological mapping.

Main Results:

• PCC achieves immediate and substantial analgesia in over 90% of patients.
• Significant reductions in opioid consumption and improved quality of life are common.
• Adverse events are infrequent and typically transient.

Conclusions:

• PCC provides rapid, durable analgesia for selected patients with refractory cancer pain.
• Advances in imaging and neurophysiological guidance enhance accuracy and safety.
• Earlier integration into palliative care pathways can optimize outcomes.