Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients.

Abstract

PURPOSE AND METHODS The safety of percutaneous cervical cordotomy (PCC) and bilateral percutaneous cervical cordotomy (BPCC) was studied in 62 and 18 patients, respectively, with intractable malignant pain. Cordotomy was indicated for pain that did not respond to any other therapy. RESULTS After PCC, 54 patients showed satisfactory, six partial, and two no pain relief. Concerning major permanent complications, urinary retention, hemiparesis, and mirror-image pain occurred in four (6.5%), five (8.1%), and four (6.5%) patients, respectively. After BPCC, nine patients showed satisfactory, six partial, and three no pain relief. The major permanent complications were the same as after PCC, and occurred in two (11.1%), two (11.1%), and one (5.6%) patient, respectively. Sleep-induced apnea was not observed in any patient. CONCLUSION In the treatment of intractable malignant pain, localized unilaterally, if other symptomatic management fails, PCC is a recommendable procedure, particularly when pain due to movement dominates. However, due to the high incidence of complications combined with the high failure rate, BPCC is not recommended.