The late results of antero-lateral cordotomy for pain relief

The operation of antero-lateral cordotomy was carried out on 56 patients with intractable pain between 1968 and 1978. The follow-up of these patients was continued for at least three years or until death to determine the late success of this procedure. Of the 33 patients who underwent surgery for malignant pain 95% of survivors had effective relief on discharge from hospital, the success rate falling to 73% at six months, and 55% at one year of follow-up. The operation was judged successful for patients with malignant disease because of short life expectancy. Thirteen patients had chronic pain from non-malignant conditions, and 85% obtained initial relief, the success rate falling to 35% at one year, and 20% at three years of follow-up. Two patients died from respiratory failure, giving an operative mortality of 3.5%. The results and complications of open cordotomy are compared with those of the percutaneous method, and the role of this procedure discussed in relation to alternative stimulatory analgesic procedures.