This information is designed to help patients talk with their surgeon about this operation. The results and complications will vary between centres especially because this operation has become quite rare.
The cordotomy operation is designed to destroy the pain pathway in the spinal cord. This can be ideal for patients with pain on one side of their body due to cancer. We have recently published our results in the peer reviewed medical Journal of Palliative Care.
Honey CR, Yeomans W, Isaacs A, Honey CM. The dying art of percutaneous cordotomy in Canada.
J Palliat Med. (2014) 17:624-628.
Click the link to download the paper: The dying art of percutaneous cordotomy in Canada
Cancer pain is most often due to a tumour destroying the normal tissue around it. Pain from the damaged tissue is carried up to the brain through a well known pathway in the spinal cord called the spinothalamic tract. If the spniothalamic tract is deliberately cut (or burned) by a neurosurgeon, then no pain from that part of the body can be transmitted to the brain. This can be a wonderful benefit to patients with severe cancer pain if:
1. their medications can not block the pain, or
2. the high dosage of the medications required to block their pain is causing intolerable side effects (e.g. sedation)
The operation at our centre is performed with local anesthesia and a brief bolus of sedation. The procedure is performed in the CT suite (cat scanner) not the operating room and the benefits are felt immediately. A needle is advanced through the side of the patient’s upper neck towards their spinal cord. An electrode is then placed into their spinal cord. While the patient is awake, the electrode is used to send pulses of electricity into the spinal cord. If the electrode is in the correct position, the patient will feel warmth in the part of the body where the pain relief is desired. If the electrode is in the wrong location, the patent will have muscle contractions in their arms or legs. After physiologic confirmation of the ideal electrode location, a small lesion is deliberately made under brief sedation. Following the lesion, the patient will not longer be able to feel pain or temperature on the opposite side of the body. Not being able to feel pain is the goal of the operation. Not being able to feel temperature (hot or cold) is a side effect of the operation and usually has no significance for the patient. Interestingly, the patient is still able to feel touch – they are not numb and do not describe ‘pins and needles’ – they just lose the ability to feel pain within the targeted area.
After the operation, the palliative care team typically aggressively reduces the pain medications (e.g. morphine). Occasionally all these medication are stopped but usually some is still given by mouth.
The benefit of this operation is a dramatic reduction (usually complete absense) of pain on one side of the body.
The potential danger of this operation would be an unwanted injury to the spinal cord. This is rare but has been well reported in the literature. Damage to the spinal cord could result in weakness of the body on the opposite side of the pain (approxiamtely 10%), difficulty with bladder function (approximately 10%), and there have been reports of death shortly after surgery (not at our centre). An incomplete lesion would leave residual pain. The benefit has been reported to typically last a year and therefore patients are usually selected for this operation if their expected lifespan is less than a year.
The pain pathway (spinothalamic tract) usually carries pain from the opposite side of the body. Therefore a right cordotomy is used to eliminate pain from the left side of the body. We have not performed bilateral cordotomies although they have been previously described in the literature. If a patient has a right cordotomy to eliminate left sided body pain and then later develops right sided body pain, the cordotomy will not stop that new right sided pain This is very much a one sided operation and we are therefore looking for patients with one sided pain for this procedure.