Percutaneous Cervical Cordotomy for the Management of Pain from Cancer: A Prospective Review of 45 Cases

Background: Percutaneous cervical cordotomy (PCC) is a well recognized but infrequently performed procedure for the relief of unilateral intractable pain from malignancy. There is a paucity of data regarding efficacy and safety of PCC. Objectives: The study's objectives were to demonstrate the efficacy and safety of PCC in cancer pain. Design: The study was a prospective review of 45 cases undergoing PCC at a tertiary referral center over a three-year period. Settings/Subjects: All patients were suffering from severe, refractory unilateral pain secondary to malignancy with poor pain relief or intolerable side effects of conventional analgesics including opioids and adjuvants. Measurements: Variables recorded preprocedure, at 2 days, and at 28 days postprocedure were numerical rating scale for maximum and average pain, oral morphine equivalent dose, and global impression of change. Adverse events and survival postprocedure were recorded. Results: Prospective data was obtained in 45 patients. Survival postprocedure ranged from 7 days to 33 months. There was a significant reduction from baseline in pain scores at 2 days and at 28 days postprocedure. Thirty-two patients experienced significant pain relief-average numerical rating scale (NRS) of zero-on day 2. Improvement in pain scores was sustained at 28 days. There were no serious adverse events observed such as respiratory failure. Conclusions: PCC is a safe and highly effective procedure to treat intractable unilateral cancer pain. It offers significant advantages over other pain control methods. Patient selection and attention to detail is paramount for a successful outcome.