Surgical Treatment of Intractable Phantom-limb Pain

Anterolateral Cordotomy – its Effectiveness in Relieving Pain of Non-Malignant Disease

“…These complain of pain only on muscle cramping with jerking of the stump, for which there is no satisfactory explanation. These results are less favourable than those reported by FALCONER (1953), who had 11 initial successes in 12 painful phantoms evenly divided between the upper and lower extremities. All were followed for over two years with only 2 late failures.…”

The effects of sensory input and concentration on post-amputation phantom limb pain

“…Its existence as a clinical problem centres around the troublesome pain with which it is sometimes associated, and it is out of attempts made to deal with this pain that the majority of investigations have arisen. Therapy has generally focused on the stump and its centripetal pathways: the percussion treatment of Russell and Spalding (1950), the stump injections described by Leriche (1950), various local surgical manoeuvres mentioned by Gillis (1954), or tractotomy, as described by Falconer (1953). Where these have failed there have been attempts to alter central nervous events of a higher order by leucotomy so as to change the patient's general reaction to pain, operations which were evaluated by Elithom, Glithero, and Slater in 1958. Apart from leucotomy, these are all direct attempts to interfere with sensations conducted centrally from the stump.…”

Four-Decade Maintenance of Analgesia with Percutaneous Cordotomy

“…The malignancies most commonly treated include pulmonary malignancies, mesothelioma, Pancoast tumors, gastrointestinal carcinoma, and metastatic carcinoma [7]. Cordotomy has also been performed to relieve pain from noncancer causes such as electrical burns, Ehlers-Danlos syndrome, pancreatitis, vascular abnormality, spinal perineural cysts, postherpetic neuralgia, tuberculosis, phantom limb pain, cauda equina injury, radiculopathy, joint pain, arachnoiditis, unsuccessful back surgery, and gunshot trauma [7,9,39,40,41,42,43,44]. However, despite the unusual longevity of analgesia in our patient, we do not recommend percutaneous cordotomy for noncancer pain.…”