Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain

OBJECTIVE: The author presents data to support the continued need for ablative procedures, particularly cordotomy, in the management of cancer-related pain. METHODS: Fifty-one patients with cancer-related body or face pain were treated with computed tomography-guided radiofrequency ablation of the spinothalamic tract or trigeminal tract nucleus in the upper cervical region of the spinal cord. Forty-one patients underwent a unilateral cervical cordotomy, and 10 patients underwent a trigeminal tractotomy-nucleotomy. Three methods to assess patient pain were used: degree of pain relief, Visual Analog Scale, and total sleeping hours. The Karnofsky scale was used to measure the patient's level of function pre- and postprocedure. RESULTS: After surgical intervention, patients reported initial and 6-months follow-up pain relief as 98 and 80%, respectively. CONCLUSION: Computed tomography-guided ablation of the upper cervical spinal cord is a safe and effective procedure to treat cancer pain involving the body or face. There remains a need for ablative procedures, in particular cordotomy, in the management of cancer-related pain. Copyright © by the Congress of Neurological Surgeons.