Bilateral Percutaneous Cervical Radiofrequency Cordotomy

HE development of percutaneous techniques has made it necessary to revise some of the former criteria for cordotomyY -',1~ The ease, simplicity, and safety of percutaneous cordotomy have increased in number the patients for whom the procedure can be used. These factors, together with the associated relief from pain, have resulted in our use of the percutaneous method in an initial series of 400 patients subjected to more than 600 cordotomies in a 2-year period. Previously on this service only 20 to 30 open cordotomies would have been done in a comparable period. Among the 400 patients was a group of 100 who required bilateral lesions. This report will review data from the 225 cervical percutaneous cordotomies performed on these 100 patients. Methods and Material The technique for percutaneous radiofrequency cervical cordotomy is that described previously 17 with the following modification. An omnidirectional cineradiographic unit is now used exclusively for radiographic visualization. During placement of the cordotomy needle, a specific attempt is made to introduce 0.2 to 0.5 ml of 1.5% lidocaine into the epidural space; when the needle enters the subarachnoid space an additional 0.1 ml is injected intrathecally. The radiofrequency lesion is made progessively with 2.5 sec increments, rather than 5 sec. Once the desired level of analgesia is attained, the last time-exposure is repeated three times, or a total of four, to assure more complete necrosis. This last modification was instituted with the sixteenth patient in this series and probably represents the reason for the better long-term results in those patients who followed.