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Objective: Study of percutaneous computed tomography (CT)-guided transdiscal low cervical cordotomy undertaken to treat pain in cancer patients. Methods: At the Department of Neurosurgery, Ain Shams University, Cairo, Egypt, 8 cancer pain patients, with either impaired pulmonary function or a previous cordotomy on an opposite side (sleep apnea was a feared complication) that prevented the possibility of undergoing a C1–2 cordotomy, underwent a percutaneous CT-guided transdiscal low cervical cordotomy (C4–5 or C5–6) to treat cancer pain. Results: Seven patients experienced initial improvement. One patient re-experienced pain within 2 weeks and 1 patient experienced no pain relief. In 6 patients in whom the cordotomy procedure was completed, satisfactory or complete pain relief, throughout a 6-month follow-up period was reported. In contrast, in 2 patients in whom the cordotomy was not completed there was no persistent pain relief. Conclusion: Percutaneous CT-guided cordotomy remains a successful procedure to control pain in cancer patients, and is an affordable viable option under circumstances where economic disadvantage is an overriding determinate. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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In this article the technique of CT-Guided Selective Cordotomy is described. The advantages of CT guidance in percutaneous cordotomy are the measurement of spinal cord diameters at the lesion site for each individual patient, direct visualization of target electrode relations, demonstration of spinal cord displacement during the procedure and localization of the electrode system in a specific part of the spinothalamic tract. Local destruction of the spinothalamic tract leads to selective cordotomy. Since 1987, CT-Guided Cordotomy has been applied to 54 cases of intractable cancer pain. In 33 of the 54 cases, the cordotomy was selective enough to be successful with a local denervation of the area where the pain was dominant. Except for one temporary hemiparesis and one temporary ataxia, no complications or side effects were observed. [ABSTRACT FROM AUTHOR]