Cordotomy

Cordotomy is a surgery that is done to destroy certain nociceptive (that conduct pain) nerves of the spinal cord and stop the pain signals from a particular area of the body from reaching the brain. 

This procedure is carried out for long-term (chronic) pain. Your doctor may initially treat your pain with non-surgical methods like medications and injections; however, if these treatments do not provide relief from pain, a cordotomy may be advised to reduce your pain sensations.

The surgery is performed with a needle that is guided into the spine with the help of x-ray imaging and then heated to destroy the target nerves.

Cordotomy is generally performed when a person has pain due to the following conditions that do not go away with other treatments:

• Cancer
• Unilateral malignancies (tumour in one side of the body)
• Lower limb disorders such as severe pain due to cancer or noncancerous conditions such as paraplegia, sciatica, painful scars, osteoarthritis, peripheral vascular disease, and amputation stump pain.
• Chronic pain caused due to physical trauma (nociceptive conditions)
• Spine surgery failure

A surgeon may not perform this procedure if you have:

• Severely reduced respiratory function
• Coagulation (blood clotting) disorder
• Are not able to cooperate (unable to report the pain or temperature sensation during surgery, e.g., in the case of children)

Before undergoing this surgery, you will need the following preparations:

• Your doctor will conduct a physical examination to check your overall health before the surgery. He/she may ask you to undergo a few diagnostic tests such as blood tests, urine tests, and pregnancy test or imaging scans like magnetic resonance imaging (MRI). 
• Share a list of all the medications that you take, including prescribed or non-prescribed medicines, herbs, minerals, vitamins, and supplements. 
• You will be asked to stop the usage of blood-thinning medicines like aspirin, ibuprofen, vitamin E, or warfarin for a few days before the surgery. This will reduce the risk of bleeding during the operation.
• Your doctor should know if you are on chemotherapy (a treatment for cancer that uses anti-cancer drugs to destroy fast-growing cells in the body).
• The doctor should be informed if you are sensitive to any food items, medicines, or surgical materials like iodine, skin cleaning solution, latex, or skin tapes. 
• If you smoke, you will be asked to stop smoking. This helps to recover quickly after the surgery.
• Make sure to ask a friend or family member to drive you home after the surgery.
• You will need to sign an approval or consent form if you agree to the procedure.

Once you reach the hospital, the medical staff will give you a hospital gown to change into. In the operating room, you will be asked to lie on your back and keep your head on a headrest. The surgeon will mark the surgical site on your neck. This is generally on the side of the body opposite to the painful area. An intravenous (IV) line will be started in a vein in your arm to provide you with fluid and medications before and after the procedure. An anesthesiologist will give you local anaesthesia to numb the surgical area. The medical staff will constantly monitor your blood circulation and breathing during the surgery.

The surgery is done in the following way:

• The surgeon will use X-rays to guide a needle inside the fluid-filled area around your spine. 
• Once the needle is placed correctly, he/she will insert another special needle through this needle into your spine.
• Then, the surgeon will pass electric current through this special needle to stimulate the sensory nerves in your spine and test whether the needle is in the correct location. You will be asked to describe the sensation and the location of the sensation generated by this stimulation. This may need to be repeated with adjustment in the placement of the needle.
• When you get a feeling of coldness or hotness in the painful area, the surgeon will heat the needle tip for a minute. He/she will assess the sensation this generates in your body (you will get a pinprick-like sensation on one side of your body).
• The surgeon will heat the needle again for a minute more to complete the procedure and then remove it from your spine.
• Finally, he/she will cover the operated area with a dressing.

About 30 to 90 minutes are required to complete this procedure. After the surgery, the medical staff will take you to the recovery room and later on to your room (hospital ward). A nurse will check your vital signs such as body temperature, pulse rate, and breathing rate. You will need a hospital stay of about three to five days.

You will need to take the following care at home after a cordotomy:

Wound care: 

• Keep the area of surgery dry and clean.
• Avoid soaking your wound in the bathtub or pool.
• Wash your hands before touching the wound.
• It is normal to have some clear fluid coming out from the surgical site.

Pain management: 

• Your doctor may prescribe you medications to reduce the pain at the operation site.

Driving: 

• You must avoid driving, especially when you are taking medications for pain.

Activities:

• Avoid strenuous activities after the surgery until your doctor allows you to. 
• The doctor may ask you to avoid lifting heavy objects for a few days after the procedure. 
• Do not sit in one place for a long time to prevent swelling in your legs. 
• You will be asked to perform a few exercises to help you regain the strength in your neck after the operation.

When to see the doctor?

Visit or call your doctor if you experience the following symptoms after the surgery:

• Fever 
• Chest pain 
• Cough 
• Difficulty in breathing 
• Fainting 
• Rapid heartbeats 
• Dizziness 
• Nausea or vomiting 
• Pain, redness, swelling, soreness, or leaking at the surgery site 
• Constipation

Cordotomy is known to carry the following risks:

• Bleeding
• Infection
• Allergy to anaesthesia 
• Breathing problem 
• Headache
• Problems in lungs
• Shock
• Bruising at the needle insertion site 
• Difficulty in urinating 
• Lack of cold or hot sensation 
• Weakness in the legs 
• A smaller pupil on the side of the surgery and drooping eyelids

Your doctor will call you again for a follow-up to inspect your wound and overall health after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.