Effects of Percutaneous Cervical Cordotomy on Pulmonary Function

LTHOUGH Schuller '-''~ in 1910 had first suggested the deliberate section of the anterolateral spinal cord for the relief of pain, it was not until 2 years later that Martin, at the urging of Spiller, ~6 performed the initial dorsal cordotomy in man. Foerster 4 is credited with having done the first cervical cordotomy. Concern that high cervical cordotomy would lead to respiratory disturbances, particularly when bilateral, was expressed early, s and reports of apnea and death consequent to the procedure have been recorded. 1~,-~; Ogle, et at., 1~ established that respiratory dysfunction must be considered a calculated risk with cervical cordotomy. They described a transient paresis of the ipsilateral intercostal muscles and diaphragm following high cordotomy in almost all cases, whether symptomatic or not. The paresis was thought to be secondary to disturbance of the motor cells or suprasegmental motor tracts supplying the diaphragm and auxiliary muscles of respiration. However, no anatomical evidence was presented to support this conclusion so that this hypothesis, to the exclusion of involvement of other neural segments of the controlling mechanism of respiration, remains presumptive. Belmusto, et al., 2 supplied documentation of an intraoperative reduction of tidal volume immediately following section of the ventral quadrant, the majority under general anesthesia. However, two patients operated on under local anesthesia did not show any respiratory alteration. One of their patients