Cordotomy

Pain is usually managed with non-surgical methods such as oral medications, injections and nerve blocks. When these options fail and severe pain turns into a chronic condition, cordotomy may be the next step for you. Cordotomy can help significantly relieve pain in up to 80 percent of select patients who undergo the procedure.

What is a cordotomy?

Cordotomy is a neurosurgical procedure in which an image-guided needle is used to make a very precise lesion (tissue change) in the spine. The procedure treats chronic pain by targeting and disabling specific nerves that are sending pain signals. While this procedure involves creating a lesion in the spine, when done appropriately with adequate monitoring, it can be done safely and effectively. The procedure does not require implants, long-term maintenance, programming or battery replacements. Moreover, it is very effective for certain diagnoses for which spinal cord stimulation has not been effective, such as cancer-related pain.

Am I a candidate for cordotomy for pain management?

If medications and other therapies fail to treat your pain symptoms, your doctor may consider surgical options. You may also be a candidate for DREZ lesioning if you experience:

• Cancer pain on one side of the body

What happens during a cordotomy?

In preparation for surgery, your doctor will order a specialized MRI to evaluate your cervical spine anatomy. It will be used to pinpoint the precise area of your spine to target.
You are placed under general anesthesia. Your doctor will evaluate your spinal fluid by performing a spinal tap (also called a lumbar puncture). Using CT scan guidance, a radiofrequency needle is placed in the spinal cord. Once optimal positioning is confirmed with imaging and physiological testing, a very focused lesion is created in the spine. Spinal cord function is functioned throughout the procedure to reduce the risk of numbness or weakness after the surgery.

What to expect after a cordotomy?

Cordotomy relieves symptoms, but it is not a cure. In carefully selected patients, up to 80 percent experience immediate pain relief, although long-term efficacy is not as reliable. Therefore, this is usually reserved for patients with severe pain who may be nearing the end of treatment options for their cancer diagnosis.

Interested in cordotomy at UCLA? Get prepared for your first appointment.