Abstract ID: A11
Abstract Title: Pain arising from vertebral malignant invasion: role of percutaneous cervical cordotomy
Poster Type: Either
ABSTRACT BODY
Introduction:Percutaneous cervical cordotomy (PCC) interrupts the spinothalamic tract at the C1/C2 level causing contralateral loss of pain sensation. PCC is the appropriate treatment of intractable malignant pain, mainly incident, localized unilaterally, particularly when medical pain therapy is ineffective and limited by harmful side effects (1). There are some reports underlying that PCC could be also efficacious to relief incident pain due to vertebral patological fractures (2)
Case Report: Three patients with severe cancer pain underwent PCC in the period between February to May 2004 . Patients referred pain due to right lumbo - sacral plexopathy from colon cancer (n.2), or prostate cancer (n.1) ; moreover all of them had a severe pain at movement and at rest arising from dorsal and lumbar vertebral metastatic body fractures. Patients were not good candidates to surgical stabilization or vertebroplasty. The median daily dose of morphine before cordotomy was 210 ± 15 mg p.o. associated with untolerable side effects at rest and recrudescence of pain particularly at movement or bed lying .After informed written consent, percutaneous cordotomy was performed at C1/C2 by radiofrequency with the auxilium of fluoroscopy .
Discussion:Cordotomy provided excellent controlateral pain relief up to T2, with improvement of ability to move. We observed also a complete disappearance of vertebral pain as demonstrated by the ability of patients to lie in the bed . The daily dose of morphine decreased drastically in all patients (16 ± 2 mg p.o.) with disappearance of side effects. Due to adequate pain resolution two patients were able to undergo radiotherapy of vertebral bodies (where indicated)while the third could start rehabilitation programm for both legs. No complications due to technique have been recorded.
Percutaneous cervical cordotomy resulted a valuable method for treatment of incident pain of malignant origin due to plexus and vertebral metastatic invasion.
Bibliography
1)Jackson MB, Pounder D, Price C et al. Percutaneous cervical cordotomy for the control of pain in patients with pleural mesothelioma. Thorax 1999;54:238-41
2)Rosen S. Percutaneous cordotomy in Interventional Pain Management p 682-698, SD Waldman ed, 2001
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A11