Contralateral approach for ipsilateral target: Stimulation-guided percutaneous cordotomy for refractory cancer pain -...

Percutaneous cervical cordotomy is an advanced neuroablative technique used in the management of medically refractory cancer pain, particularly in patients with unilateral body or limb pain. The procedure is based on targeting the spinothalamic tract (STT) on the side contralateral to the patient's pain, guided by clinical findings and topographic anatomy. However, standardized and reliable guidance on how to interpret ipsilateral sensory responses that may occur during intraoperative stimulation remains limited in the current literature. In this case report, we discuss an ipsilateral (pain-side) cordotomy performed in a patient with axial left-sided back pain who exhibited atypical and uncommon ipsilateral sensory responses during a contralateral approach. Based on computed tomography (CT) guidance and real-time intraoperative stimulation, the electrode was advanced to the ipsilateral side, and the procedure was completed accordingly.