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.
Keywords: Analgesic opioid therapy, Cordotomy, Metastatic disease, Nerve blocks, Spinal chordotomy.
