Palliative CT-Guided Cordotomy for Medically Intractable Pain in Patients with Cancer

SUMMARY: Palliative cervical cordotomy can be performed via percutaneous radiofrequency ablation of the lateral C1–2 spinothalamic tract. This rare procedure can be safe, effective, and advantageous in mitigating medically intractable unilateral extremity pain for selected patients with end-stage cancer. This report reviews the indications, techniques, risks, and potential benefits of cordotomy. We describe our recent experience treating 3 patients with CT-guided C1–2 cordotomy and provide the first characterization of spinal cord diffusion MR imaging changes associated with successful cordotomy.