The Dying Art of Percutaneous Cordotomy in Canada

HoneyChristopher, R; YeomansWendy,; Isaacs, Albert M.; Michael, HoneyC.

doi:10.1089/jpm.2013.0664

Cited by 13 publications

(13 citation statements)

References 15 publications

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“…These patients are often not mobile and cannot travel long distances to get the pump refilled, in addition they are often immunocompromised and have an increased risk of hardware infection. They require immediate pain relief with a therapy that does not interfere with their daily routine, be it oncological treatment or hospice care [3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Strauss

Berger²,

Arad

et al. 2017

Stereotact Funct Neurosurg

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Background: Pain is often one of the most debilitating symptoms in patients with advanced oncological disease. Patients with localized pain due to malignancy refractory to medical treatment can benefit from selective percutaneous cordotomy that disconnects the ascending pain fibers in the spinothalamic tract. Objectives: Over the past year, we have been performing percutaneous radiofrequency cordotomy with the use of the O-Arm intraoperative imaging system that allows both 2D fluoroscopy and 3D reconstructed computerized tomography imaging. We present our experience using this technique, focusing on technical nuances and complications. Methods: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy between March 2016 and March 2017. Results: Nineteen patients underwent percutaneous cordotomy procedures. Two patients developed intraoperative delirium and were unable to tolerate the procedure. In 16 out of 17 completed procedures, we achieved excellent immediate pain relief (94%). At 1 month after operation, 15 of the 17 (88%) patients were pain free, and at 3 months 5 out of 5 patients available for follow-up were still free of their original pain. Mirror pain developed in 6 of the 17 patients (35%), but was mild in 4 of these cases and controlled with medications. We experienced 1 serious complication (6%) of ipsilateral hemiparesis. Conclusion: Percutaneous cordotomy using the O-Arm is safe and effective in the treatment of intractable oncological pain.

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Section: Introductionmentioning

confidence: 99%

O-Arm-Guided Percutaneous Radiofrequency Cordotomy

Strauss

Berger²,

Arad

et al. 2017

Stereotact Funct Neurosurg

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“…This impacts patients, who may already have significant morbidity from their illness, who then have to travel substantial distances to be considered for a PCC. Internationally, this decline is also recognised with cordotomy being considered a ‘dying art’ within North America and the practice of PCC being infrequently used 15. Within the last decade, only three medical centres within the USA have reported on their PCC performance 16.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous cervical cordotomy for cancer-related pain: national data

Poolman

Makin

Briggs

et al. 2020

BMJ Support Palliat Care

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ObjectivesPercutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess the effectiveness and safety of PCC.MethodsAnalysis was undertaken of the first national (UK) prospective data repository of adult patients with cancer undergoing PCC for pain treatment. The relationship between pain and other outcomes before and after PCC was examined using appropriate statistical methods.ResultsData on 159 patients’ PCCs (performed from 1 January 2012 to 6 June 2017 in three centres) were assessed: median (IQR) age was 66 (58–71) years, 47 (30%) were female. Mesothelioma was the most common primary malignancy (57%). The median (IQR) time from cancer diagnosis to PCC assessment was 13.3 (6.2–23.2) months; PCC to follow-up was 9 (8–25) days; and survival after PCC was 1.3 (0.6–2.8) months. The mean (SD) for ‘average pain’ using a numerical rating scale was 6 (2) before PCC and 2 (2) at follow-up, and for ‘worst pain’ 9 (1) and 3 (3), respectively. The median (IQR) reduction in strong opioid dose at follow-up was 50% (34–50). With the exception of ‘activity’, all health-related quality of life scores (5-level version of EuroQol-5 Dimension) either improved or were stable after PCC. Six patients (4%) had PCC-related adverse events.ConclusionsPCC is an effective treatment for cancer pain; however, findings in this study suggest PCC referrals tended to be late in patients’ disease trajectories. Further study into earlier treatment and seeking international consensus on PCC outcomes will further enhance opportunities to improve patient care.

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“…However, medically refractory, unilateral nociceptive pain, where prognosis is less than 1 year is deemed appropriate. 2 Holistic multidisciplinary care is essential to manage pain and recognise suitable cordotomy candidates. 2,3 While percutaneous cordotomy is recognised as an effective and less invasive technique, the neurosurgical expertise at our centre is in open cordotomy.…”

Section: Clinical-scientific Notesmentioning

confidence: 99%

“…2 Holistic multidisciplinary care is essential to manage pain and recognise suitable cordotomy candidates. 2,3 While percutaneous cordotomy is recognised as an effective and less invasive technique, the neurosurgical expertise at our centre is in open cordotomy. 4 The open cordotomy procedure is performed under general anaesthetic via a laminectomy technique.…”

Section: Clinical-scientific Notesmentioning

confidence: 99%