Open Thoracic Anterolateral Cordotomy – Is There Still Room?

Carlos Alberto Miranda Lyra; Ângelo Marcel Santana Duarte Araujo; Dimas Fernandes Vasconcelos Júnior; Danilo Medeiros Menezes Sá; Arthur Maynart Pereira Oliveira; Rilton Marcus Morais; Clement Hamani; Ricardo Ferrareto Iglesio; Daniel Ciampi de Andrade; Pedro Henrique Martins da Cunha; Jorge Dornellys da Silva Lapa

doi:10.1055/s-0045-1809634

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2025; 44(02): e122-e130
DOI: 10.1055/s-0045-1809634

Review Article

Open Thoracic Anterolateral Cordotomy – Is There Still Room?

Cordotomia anterolateral torácica aberta – Ainda há espaço?

Authors

Carlos Alberto Miranda Lyra

¹Neurosurgery Unit, Fundação de Beneficência Hospital de Cirurgia, Aracaju, SE, Brazil
Ângelo Marcel Santana Duarte Araujo

²Universidade Tiradentes (Unit), Aracaju, SE, Brazil
Dimas Fernandes Vasconcelos Júnior

¹Neurosurgery Unit, Fundação de Beneficência Hospital de Cirurgia, Aracaju, SE, Brazil
Danilo Medeiros Menezes Sá

¹Neurosurgery Unit, Fundação de Beneficência Hospital de Cirurgia, Aracaju, SE, Brazil
Arthur Maynart Pereira Oliveira

¹Neurosurgery Unit, Fundação de Beneficência Hospital de Cirurgia, Aracaju, SE, Brazil
Rilton Marcus Morais

¹Neurosurgery Unit, Fundação de Beneficência Hospital de Cirurgia, Aracaju, SE, Brazil
Clement Hamani

³Harquail Centre for Neuromodulation, Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
Ricardo Ferrareto Iglesio

⁴Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, School of Medicine, São Paulo, SP, Brazil
Daniel Ciampi de Andrade

⁵LIM-62, Pain Center, Department of Neurology, Universidade de São Paulo, São Paulo, SP, Brazil

⁶Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
Pedro Henrique Martins da Cunha

⁵LIM-62, Pain Center, Department of Neurology, Universidade de São Paulo, São Paulo, SP, Brazil
Jorge Dornellys da Silva Lapa

¹Neurosurgery Unit, Fundação de Beneficência Hospital de Cirurgia, Aracaju, SE, Brazil

⁵LIM-62, Pain Center, Department of Neurology, Universidade de São Paulo, São Paulo, SP, Brazil

Abstract

Introduction

Cancer pain encompasses multiple mechanisms, thus falling under the classification of mixed pain. Cordotomy for oncologic pain has been performed since a long time ago, as an open surgical technique or a percutaneous approach.

Objective

We describe here the successful application of an open thoracic cordotomy to treat a young patient with advanced cervical cancer. Additionally, a scoping review was conducted, focusing on the efficacy of open cordotomy for the treatment of cancer pain.

Methods

Following PRISMA guidelines, Medline and Embase were searched for articles reporting open cordotomy to treat mainly oncologic pain. Event rates related to pain and adverse events were recorded and amalgamated between studies. Studies written in English, Portuguese, or Spanish, and published between 1960 and 2023 were included.

Results

Of 495 abstracts retrieved, 22 articles were selected for full-text review, of which 10 manuscripts ultimately met inclusion criteria and were pooled for review. A total of 305 patients treated with an open cordotomy were reported in 10 articles, a complete or partial relief of the pain was present in 90% of the patients and only 10% showed a bad pain response after the procedure. Urinary incontinence, motor weakness, and death have been reported in 13%, 7,5%, and 3% of the studies, respectively.

Conclusions

Pain improvement was observed in patients who underwent open cordotomy with an acceptable risk of complications. However, prospective studies in the area are needed to confirm efficacy. Furthermore, new technologies should be explored for tailoring open cordotomy.

Resumo

Introdução

A dor do câncer envolve múltiplos mecanismos, caindo assim na classificação de dor mista. A cordotomia para dor oncológica é realizada há muito tempo, como uma técnica cirúrgica aberta ou uma abordagem percutânea.

Objetivo

Descrevemos aqui a aplicação bem-sucedida de uma cordotomia torácica aberta para tratar um paciente jovem com câncer cervical avançado. Além disso, uma revisão de escopo foi conduzida, com foco na eficácia da cordotomia aberta para o tratamento da dor do câncer.

Métodos

Seguindo as diretrizes PRISMA, foram pesquisados artigos no Medline e Embase que relataram cordotomia aberta para tratar principalmente dor oncológica. As taxas de eventos relacionados à dor e eventos adversos foram registradas e agrupadas entre os estudos. Foram incluídos estudos escritos em inglês, português ou espanhol e publicados entre 1960 e 2023.

Resultados

Dos 495 resumos recuperados, 22 artigos foram selecionados para revisão de texto completo, dos quais 10 manuscritos preencheram os critérios de inclusão e foram agrupados para revisão. Um total de 305 pacientes tratados com cordotomia aberta foram relatados em 10 artigos, um alívio completo ou parcial da dor esteve presente em 90% e apenas 10% apresentaram uma resposta dolorosa ruim após o procedimento. Incontinência urinária, distúrbios do movimento e morte foram relatadas em 13%, 7,5% e 3% dos estudos, respectivamente.

Conclusões

Foi observada melhora da dor com complicações aceitáveis nos pacientes submetidos à cordotomia aberta. No entanto, estudos prospectivos na área são necessários para confirmar a eficácia. Além disso, novas tecnologias devem ser exploradas para adaptar e refinar a cordotomia aberta.

Keywords

chronic pain - spinal cord - cordotomy - cancer pain

Palavras-chave

dor crônica - medula espinhal - cordotomia - dor oncológica

Full Text

References

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