Abstracts from other journals

Abstract

S FROM OTHER JOURNALS PERCUTANEOUS ELECTRICAL CORDOTOMY IN RELIEF OF INTRACT­ ABLE PAIN: LIPTON, S. (1968). Br. med. J. 1,210. This appears to be the first publication in Britain on percutaneous cordotomy for intractable pain. A stereotaxic technique using modifications of the methods of Mullan and of Rosomoff was used in 52 patients. The best way to produce the lesion in the anterolateral tract, at the atlanto-axial level, was by using a radio-frequency current, after electrical stimulation was carried out to confirm correct placement of the electrode in the spinal cord. The author claims that this method of treatment is a much lesser surgical procedure than open operative cordotomy; also, compared to the latter procedure there is less morbidity and mortality, and a shorter period of convalescence. Forty-four patients had 52 unilateral cordotomies, 30 with relief of pain, and 4 with partial relief; 2 failed and required open surgery, 2 had retention of urine and 2 had transient paresis. In the 8 patients with bilateral cordotomies, there were 17 percutaneous operations. Five had relief of pain, and 3 partial relief, 2 had bladder paralysis and one arm paresis. No details are given of the levels and areas of analgesia achieved; and no information is given about the spinal cord lesions produced in those patients who died (most had serious progressive malignant disease )-that is information about the precise site and size of the radiofrequency lesion. SOMATOTOPIC REPRESENTATION OF THE RESPIRATORY PATHWAYS IN THE CERVICAL CORD OF MAN: HITCHCOCK, E. & LEECE, B. (1967). J Neurosurg. 27, 320. This important paper is based on a careful preand post-operative study in 14 patients who required high cervical cordotomy for intractable pain. Pulmonary function tests were carried out-vital capacity, forced expiratory volume, peak expiratory flow and radiological assessment of diaphragmatic excursion. Automatic respiration appears to be mediated through the reticulo-spinal pathways which lie in the antero-lateral aspect of the cervical spinal cord. The authors suggest that fractional cervical cordotomy can result in satisfactory analgesia without injuring the respiratory pathways. The relevance of this work in relation to patients with cervical spinal cord damage is important, and the authors stress the situation where the patient can breath by voluntary effort but has no rhythmic automatic respiration; and mention that the conception of