Microendoscopic Intradural Cordotomy for the Treatment of Cancer Pain

Spinal chordotomy is an alternative to analgesic opioid therapy, nerve blocks, and subcutaneous or intravenous techniques for cancer-induced pain. Patients with advanced metastatic disease require significant pain relief. Unfortunately, not all patients respond well to the standard therapies. For these patients, cordotomy offers a potential breakthrough. Cordotomy involves thermally disrupting the nociceptive pathways in the anterior spinothalamic tract to interrupt pain transmission from the spinal cord to the brain. The anterior spinothalamic tract is responsible for somatic pain sensations, touch, and temperature discrimination. This chapter presents an endoscopic-assisted percutaneous anterolateral radiofrequency intradural cordotomy technique. The entire procedure is done under direct endoscopic visualization of the cervical spinal cord. The authors provide an up-to-date summary of targeted minimally invasive pain intervention, which utilizes controlled electrical stimulation to confirm the physiological target. It is associated with less trauma to surrounding spinal tissue and lower risks due to vascular injury or adverse effects of intrathecal contrast.