Five-year follow-up of a cordotomy.

Percutaneous cervical cordotomy is an invasive procedure to treat severe, opioid-resistant cancer pain. It is usually proposed for patients with a limited life expectancy. As a consequence, objective quantification of the long-term effects of this procedure is lacking. The present report describes a patient who was treated with a right-sided percutaneous cervical cordotomy for refractory cancer pain. Afterward, disseminated seminoma was diagnosed, which was cured with chemotherapy. Five years after the procedure, a qualitative and quantitative evaluation of the long-term effects was performed. Sensory dysfunction was observed in the left side of the body, but no motor neuron or autonomic dysfunction was observed. The influence of these long-term effects on the patient's daily activities was limited.

The management of chronic spinal pain by blockades: a review.

This review of the use of blockades in the diagnosis and symptomatic treatment of spinal pain syndromes is based on increasing knowledge of the innervation of the spine as their rationale. Several clinical syndromes related to the spine are considered. Problems in making a correct diagnosis are discussed. Because of the relative aspecificity of signs and symptoms in spinal pain, a substantial part of the diagnosis may rely on test blockades. The place of test and therapeutic blocks is determined as far as possible. Problems of a pain classification system are discussed. Benefit for the patient depends on the following conditions being achieved: correct diagnosis, careful patient selection, the availability of technical equipment (e.g., fluoroscopy), and a well-designed and well-performed technique in experienced hands.

Electrode positioning in thoracic percutaneous partial rhizotomy: an anatomical study.

The present study was undertaken to clarify if needle positioning in percutaneous partial rhizotomy in the thoracic area based on bony landmarks and guided by fluoroscopic control leads to adequate placement in or at the targeted nervous tissue, i.e., the dorsal root ganglion (DRG), and to determine if needle localization by CT is more reliable than by fluoroscopic control. An investigation was performed in 2 cadavers, simulating the clinical setting as much as possible. At the levels T1-T8 a drill hole was made in the vertebral arc with a Kirschner wire. At the levels T9-T12 the "classic" dorsolateral technique was used. In 46 procedures the position of the needle tips was compared using hard copies of the fluoroscopic images, CT images at 1.5 mm intervals, surface photographs, and stained 25 microns sections obtained by a multirange heavy duty cryomicrotome. The position of the DRG in the foramen, and its size, were measured. In the sections, considered as the "golden standard", in 28 cases (60.9%) the needle tip was found in the DRG and in the extradural dorsal root in 14 cases (30.4%). In 4 cases (8.7%) no nervous tissue was encountered. In 8 of 32 "drill hole procedures" the facet joint was pierced. No accidental pleural puncture occurred in any of the procedures. The needle position was imaged more accurately by fluoroscopy. It is concluded that fluoroscopic control is a reliable guide to needle placement in percutaneous partial rhizotomy and permits standardization of the technique with the help of bony landmarks.