Role of cervical cordotomy and other neurolytic procedures in thoracic cancer pain.

PURPOSE OF REVIEW

Evaluation of the efficacy and safety of the percutaneous cervical cordotomy (PCC) in palliative care medicine in patients suffering from thoracic cancer pain; fluoroscopy-guided versus computed tomographic-guided PCC. Evaluation of recent developments in other neurolytic procedures in thoracic pain.

RECENT FINDINGS

Technical progress has provided us with much more accurate means of visualizing the spinal cord and its subunits. Not only do these techniques provide more accuracy in placing the lesion, and thereby increasing safety and efficacy of PCC. There is also no need to use oily contrast media that is incompatible with cerebrospinal fluid and nerve tissue. Recent literature concerning intercostal nerve blocks, selective percutaneous rhizotomy, intrathecal or epidural administration of neurolytic agents is limited. Neurolytic procedures may be improved by ultrasonography-guided procedures.

SUMMARY

The results of fluoroscopy-guided PCC are satisfactory with case series reporting complete pain reduction in as much as 82-95% of the patients. For CT-guided PCC initial success rates were reported between 80.5-92.5% patients. However, the complication rates and long-term effects if measured and/or mentioned, varied. Hypothetically this technique may be more accurate and therefore probably safer than fluoroscopic-guided PCC.