Percutaneous Cordotomy, Tractotomy, and Midline Myelotomy: Minimally Invasive Stereotactic Pain Procedures

Neurosurgical Approaches to Pain Management

“…18 The spinal cord anterolateral ascending pain transmission system carries information about pain and temperature from one side of the body. The procedure was historically performed in the upper thoracic spine via an open posterior approach and, less commonly, high in the cervical spine.…”

“…Schvarcz added the term "extralemniscal" to "myelotomy" because of the contention that the lesion incorporated an ascending polysynaptic nociceptive pathway. 18 Several authors have now presented reports of midline "punctuate" ELM via open procedures to interrupt this pathway at various spinal cord levels.…”

Destructive procedures for the treatment of nonmalignant pain: a structured literature review

“…15,59 Techniques targeting different locations along the afferent pain pathway have been used for an array of pain conditions. 60,61,104,105 In addition to the anterolateral quadrant of the spinal cord, other targets of destructive surgery have included the following: the sensory and sympathetic ganglia; the dorsal and ventral spinal roots; the DREZ; and the decussating extralemniscal fibers. Despite their long history and purported efficacy, the use of destructive techniques has generally declined in modern practice, although there are a few notable exceptions.…”

“…Despite their long history and purported efficacy, the use of destructive techniques has generally declined in modern practice, although there are a few notable exceptions. 60 Destructive techniques are being replaced with newer pharmaceutical agents and nondestructive treatments, such as spinal cord stimulators and intrathecal opiate pumps. However, these techniques are not without disadvantages.…”