Commissural Myelotomy in the Treatment of Intractable Visceral Pain: Technique and OutcomesViswanathan A.a, c · Burton A.W.b · Rekito A.c · McCutcheon I.E.a
Departments of aNeurosurgery and bPain Medicine, University of Texas MD Anderson Cancer Center, Houston, Tex., and cDepartment of Neurosurgery, Oregon Health Science University, Portland, Oreg., USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Commissural myelotomy can be valuable for patients with intractable pain associated with malignancy in the abdominal or pelvic region. Methods: Between December 1992 and June 2009, 11 patients underwent commissural myelotomy at the University of Texas MD Anderson Cancer Center for the treatment of intractable lower extremity, thoracic, pelvic or sacral pain associated with unresectable tumors. The various surgical approaches to myelotomy are discussed. Results: Eight patients had excellent or good outcomes with regard to pain relief, defined as no further pain (excellent) or a significant reduction in pain and not requiring opioids stronger than codeine (good). Complications included new leg weakness (n = 3) and bladder dysfunction (n = 1). Conclusion: We found that for the properly selected patient, open midline commissural myelotomy can provide effective pain relief with acceptable postoperative morbidity.
© 2010 S. Karger AG, Basel
Spiller WG, Martin E: The treatment of persistent pain of organic origin in the lower part of the body by division of the antero-lateral column of the spinal cord. JAMA 1912;58:1498.
- Kanpolat Y: The surgical treatment of chronic pain: destructive therapies in the spinal cord. Neurosurg Clin N Am 2004;15:307–317.
- Romanelli P, Esposito V, Adler J: Ablative procedures for chronic pain. Neurosurg Clin N Am 2004;15:335–342.
Armour D: Surgery of the spinal cord and its membranes. Lancet 1927;i:691–697.
- Sourek K: Commissural myelotomy. J Neurosurg 1969;31:524–527.
- Cook AW, Nathan PW, Smith MC: Sensory consequences of commissural myelotomy. Brain 1984;107:547–568.
- Schvarcz JR: Stereotactic extralemniscal myelotomy. J Neurol Neurosurg Psychiatry 1976;39:53–57.
- Nauta HJW, Hewitt E, Westlund KN, Willis WD: Surgical interruption of a midline dorsal column visceral pain pathway. J Neurosurg 1997;86:538–542.
- Willis WD, Al Chaer ED, Quast MJ, Westlund KN: A visceral pain pathway in the dorsal column of the spinal cord. Proc Natl Acad Sci USA 1999;96:7675–7679.
- Hitchcock E: Stereotactic cervical myelotomy. J Neurol Neurosurg Psychiatry 1970;33:224.
- Gildenberg PL, Hirshberg R: Limited myelotomy for the treatment of intractable cancer. J Neurol Neurosurg Psychiatry 1984;47:94–96.
- Kanpolat Y, Savas A, Caglar S, Akyar S: Computerized tomography-guided percutaneous extralemniscal myelotomy. Neurosurg Focus 1997;2:e5.
- Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 1969;7:179–192.
- Burton AW, Rajagopal A, Shan HN, Mendoza T, Cleeland C, Hassenbusch SJ, Arens JF: Epidural and intrathecal analgesia is effective in treating refractory cancer pain. Pain Med 2004 5:239–247.
- Raslan AM, McCartney S, Burchiel KJ: Management of chronic severe pain: spinal neuromodulatory and neuroablative approaches. Acta Neurochir Suppl 2007;97:33–41.
- Al Chaer ED, Lawand NB, Westlund KN, Willis WD: Pelvic visceral input into the nucleus gracilis is largely mediated by the postsynaptic dorsal column pathway. J Neurophysiol 1996;76:2675–2690.
- Wang Y, Wu J, Lin Q, Nauta HJ, Yue Y, Fang L: Effects of general anesthetics on visceral pain transmission in the spinal cord. Mol Pain 2008;4:50.
- Kim YS, Joon KS: High thoracic midline dorsal column myelotomy for severe visceral pain due to advanced stomach cancer. Neurosurgery 2000;46:85–92.
Nauta HJW, Soukup VM, Fabian RH, Lin JT, Grady JJ, Williams CGA, Campbell GA, Westlund KN, Willis WD Jr: Punctate midline myelotomy for the relief of visceral cancer pain. J Neurosurg 2000;92(suppl): 125–130.
- Becker R, Sure U, Bertalanffy H: Punctate midline myelotomy: a new approach in the management of visceral pain. Acta Neurochir (Wien) 1999;141:881–883.
- Hwang SL, Lin CL, Lieu AS, Kuo TH, Yu KL, Ou-Yang F, Wang SN, Lee KT, Howng SL: Punctate midline myelotomy for intractable visceral pain caused by hepatobiliary or pancreatic cancer. J Pain Symptom Manage 2004;27:79–84.
- Hong D, Andren-Sandberg A: Punctate midline myelotomy: a minimally invasive procedure for the treatment of pain in inextirpable abdominal and pelvic cancer. J Pain Symptom Manage 2007;33:99–109.
- Vilela Filho O, Araujo MR, Florencio RS, Silva MAC, Silveira MT: CT-guided percutaneous punctuate midline myelotomy for the treatment of intractable visceral pain: a technical note. Stereotact Funct Neurosurg 2001;77:177–182.
- Cook AW, Kawakami Y: Commissural myelotomy. J Neurosurg 1977;47:1–6.
- Gildenberg PL: Myelotomy through the years. Stereotact Funct Neurosurg 2001;77:169–171.
- Broager B: Commissural myelotomy. Surg Neurol 1974;2:71–74.
- Papo I, Luongo A: High cervical myelotomy in the treatment of pain. J Neurol Neurosurg Psychiatry 1976;39:705–710.
- Gybels J: Commissural myelotomy revisited. Pain 1997;70:1–2.
- Goedhart ZD, Francaviglia N, Feirabend HKP, Voogd J: Technical pitfalls in median commissural myelotomy for malignant sacral pain. Appl Neurophysiol 1984;47:216–222.
- Turk DC, Dworkin RH, McDermott MP, Bellamy N, Burke LB, Chandler JM, Cleeland CS, Cowan P, Dimitrova R, Farrar JT, Hertz S, Heyse JF, Iyengar S, Jadad AR, Jay GW, Jermano JA, Katz NP, Manning DC, Martin S, Max MB, McGrath P, McQuay HJ, Quessy S, Rappaport BA, Revicki DA, Rothman M, Stauffer JW, Svensson O, White RE, Witter J: Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. Pain 2008;139:485–493.
- Kapural L, Nagem H, Tlucek H, Sessler DI: Spinal cord stimulation for chronic visceral abdominal pain. Pain Med 2010;11:347–355.
- Kapural L, Narouze SN, Janicki TI, Mekhail N: Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain. Pain Med 2006;7:440–443.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.