O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Strauss, Ido; Berger, Assaf; Arad, Michal; Hochberg, Uri; Tellem, Rotem

doi:10.1159/000484614

Cited by 11 publications

(11 citation statements)

References 17 publications

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“…Data on the long‐term effects of PCC are limited and describe a gradual decrease in analgesia in 34% to 60% of patients 9,50 and persistent analgesia in 62% 29 to 88% 26 of patients; some case reports describe long‐term analgesia 51 . Regarding the long‐term effects of PCC, our data suggest persistent pain reduction; pain reduction at 6 and 12 months after PCC was not significantly different from that at 1 week after PCC.…”

Section: Discussioncontrasting

confidence: 46%

“…In previous studies, side effects were frequent but minor and self‐limiting, such as headache or urinary retention for some days 30,32,52 . More serious side effects such as hemiparesis were observed in 6% to 8.1% of patients 26,53 …”

Section: Discussionmentioning

confidence: 94%

“…The procedure has been described, with minor variations, in many articles and textbooks 5,30,35–39 . Imaging during PCC for electrode positioning can be done with C‐arm fluoroscopy, computed tomography, 18,40–42,43 O‐arm‐guided navigation, 26 or endoscopy 33,44 …”

Section: Methodsmentioning

confidence: 99%

“…However, the duration of pain relief is debated, 23 and recurrence of pain has been described 24,25 . The occurrence of mirror pain has also been described 10,26 …”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Cervical Cordotomy for the Treatment of Cancer Pain: A Prospective Case Series of 52 Patients with a Long‐Term Follow‐Up

et al. 2021

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Aim The aim of this study is to describe the effects of percutaneous cervical cordotomy (PCC) on pain, opioid consumption, adverse events, and satisfaction in palliative care patients with cancer pain after PCC until end of life. Methods This is a prospective observational case series of 58 PCCs in 52 consecutive patients. Indication for PCC was unilateral cancer pain with a maximum numeric rating scale (NRS) of pain above 5 despite maximal conservative treatment. The PCC was fluoroscopy guided. A radiofrequency lesion was made at 95°C for 20 seconds. The pain location and pain scores, analgesic medication, the cranial and caudal borders of dermatomes hypoesthetic for pin pricks, dysesthesia, urinary retention, Horner’s syndrome, muscle strength, Karnofsky performance scale (KPS) score, patient satisfaction, hospital anxiety and distress score (HADS), and RAND 36 score were evaluated at 1 day; 1 and 6 weeks; and 3, 6, 9, 12 18, and 24 months after PCC, or until death if death occurred during the follow‐up period. Results Pain relief after PCC was intense (change in median maximum NRS from 9 to 0) and persistent. Median opioid use per day was 240 mg (145 to 565 mg) before PCC and 55 mg (0 to 120 mg) after PCC. The upper and lower borders of dermatomes hypoesthetic for pin pricks were stable over time. The most common side effects were short‐term (< 1 week) neck pain (28%), dysesthesia (40%), and mild loss of muscle strength (11%). Approximately 83% of the patients were satisfied or very satisfied with the results of PCC 1 week after the procedure, and this percentage remained high in the long term. There was no significant change in the KPS score, HADS, and RAND 36 score. Conclusion Percutaneous cervical cordotomy is an effective treatment for unilateral cancer pain. The reduction in pain, reduction in opioid consumption, and hypoesthetic area remain stable until death.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

“…However, the duration of pain relief is debated, 23 and recurrence of pain has been described 24,25 . The occurrence of mirror pain has also been described 10,26 …”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Cervical Cordotomy for the Treatment of Cancer Pain: A Prospective Case Series of 52 Patients with a Long‐Term Follow‐Up

et al. 2021

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“…1,2 A growing body of evidence demonstrates the effectiveness and safety of percutaneous cervical cordotomy (PCC) under computed tomography guidance for patients with cancer suffering from refractory pain. [3][4][5][6] Although the pain-relieving mechanism of cordotomy is straightforward, there is a lack of recorded quantitative data on its effects on the painful side and on sensation of pain on the contralateral side.…”

mentioning

confidence: 99%

Temporal Summation Predicts De Novo Contralateral Pain After Cordotomy in Patients With Refractory Cancer Pain

et al. 2021

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BACKGROUND: Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood. OBJECTIVE: To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes. METHODS: Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale). RESULTS: All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037). CONCLUSION: The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.

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