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

Abstract

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.

The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

“… 176 A recent prospective observational case series has demonstrated both reduction in pain and opioid consumption post cordotomy. 177 The incidence of new pain was variable and the underlying pathophysiology is still poorly understood, but progression of the disease and interruption of descending inhibitory pathways may play a role.…”

Effectiveness of CT‐guided percutaneous cordotomy in intractable cancer pain: Experience in 14 patients

“…The needle was advanced until the cerebrospinal fluid (CSF) was observed, and then it was used as a guide. A 2 mm active tip electrode was used in all cordotomy procedures performed with fluoroscopy or CT guidance 5–10 . This is because there are many important structures around LSTT.…”

“…A 2 mm active tip electrode was used in all cordotomy procedures performed with fluoroscopy or CT guidance. [5][6][7][8][9][10] This is because there are many important structures around LSTT. The corticospinal tract is located posterior to LSTT.…”