Sanders M, Zuurmond W
Department of Anesthesiology, Spaarne Hospital, Haarlem, The Netherlands.
J Clin Oncol. 1995 Jun;13(6):1509-12. doi: 10.1200/JCO.1995.13.6.1509.
The safety of percutaneous cervical cordotomy (PCC) and bilateral percutaneous cervical cordotomy (BPCC) was studied in 62 and 18 patients, respectively, with intractable malignant pain. Cordotomy was indicated for pain that did not respond to any other therapy.
After PCC, 54 patients showed satisfactory, six partial, and two no pain relief. Concerning major permanent complications, urinary retention, hemiparesis, and mirror-image pain occurred in four (6.5%), five (8.1%), and four (6.5%) patients, respectively. After BPCC, nine patients showed satisfactory, six partial, and three no pain relief. The major permanent complications were the same as after PCC, and occurred in two (11.1%), two (11.1%), and one (5.6%) patient, respectively. Sleep-induced apnea was not observed in any patient.
In the treatment of intractable malignant pain, localized unilaterally, if other symptomatic management fails, PCC is a recommendable procedure, particularly when pain due to movement dominates. However, due to the high incidence of complications combined with the high failure rate, BPCC is not recommended.
分别对62例和18例顽固性恶性疼痛患者进行了经皮脊髓前侧柱切断术（PCC）和双侧经皮脊髓前侧柱切断术（BPCC）的安全性研究。脊髓前侧柱切断术适用于对任何其他治疗均无反应的疼痛。
PCC术后，54例患者疼痛缓解满意，6例部分缓解，2例无疼痛缓解。关于主要的永久性并发症，尿潴留、偏瘫和镜像痛分别发生在4例（6.5%）、5例（8.1%）和4例（6.5%）患者中。BPCC术后，9例患者疼痛缓解满意，6例部分缓解，3例无疼痛缓解。主要的永久性并发症与PCC术后相同，分别发生在2例（11.1%）、2例（11.1%）和1例（5.6%）患者中。所有患者均未观察到睡眠性呼吸暂停。
在治疗单侧局限性顽固性恶性疼痛时，如果其他对症治疗无效，PCC是一种推荐的手术方法，特别是当运动引起的疼痛占主导时。然而，由于并发症发生率高且失败率高，不推荐使用BPCC。
