Pelvic/Visceral Cancer Pain

The management of medically refractory cancer pain is a complex, multi-disciplinary effort. When optimal medical management has failed, neuroablative and neuromodulatory efforts can be used. While neuromodulation is an attractive option due its minimally invasive nature, neuroablation offers the advantage of high efficacy and the lack of maintenance or upkeep requirements. Punctate midline myelotomy is an ablative procedure targeting the ascending visceral pain pathway in the dorsal columns. The procedure can be performed through an open approach creating a mechanical lesion, or percutaneously via either a mechanical lesion or radiofrequency ablation. Careful attention to the spinal cord midline during lesion creation and attention to surgical technique, including an excellent fascial closure, can minimize potential complications.