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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/20 11:06:10」(JST)

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Cordotomy (or chordotomy) is a surgical procedure that disables selected pain-conducting tracts in the spinal cord, in order to achieve loss of pain and temperature perception. This procedure is commonly performed on patients experiencing severe pain due to cancer or other diseases for which there is currently no cure. Anterolateral cordotomy is effective for relieving unilateral, somatic pain while bilateral cordotomies may be required for visceral or bilateral pain.

Cordotomy is usually done percutaneously with fluoroscopic guidance while the patient is under local anesthesia. Open cordotomy, which requires a laminectomy, is often risky for patients with poor medical conditions, but may be required if percutaneous cordotomy is not feasible or an attempt has failed.

Cordotomy is now used exclusively for pain due to cancer where treatment to level 3 of the World Health Organisation pain ladder has proved ineffective. Cordotomy is especially indicated for pain due to asbestos-related cancers such as pleural and peritoneal mesothelioma.

Although cordotomy is effective in the relief of pain, the effect is usually temporary. Dysesthesia develops after most cordotomies.^[1]

A number of alternative surgical procedures have evolved in the 20th century; these include:

Commissural myelotomy, with limited rostro-caudal range; it produces bilateral analgesia (Armour 1927; Hitchcock 1970; 74).

Limited midline myelotomy for the treatment of pelvic visceral cancer pain (Gildenberg and Hirshberg, 1984).

Dr. Elie D. Al-Chaer and his colleagues discovered in 1998 a new pathway in the spinal cord relatively specific for visceral pain - the pain that originates from visceral organs such as the colon, bladder and pancreas. The new pathway is located in the posterior columns, traditionally believed to mediate light touch and kinesthesia. This discovery led to a paradigm shift in the understanding of pain pathways and in the approach to treat intractable visceral pain. As a result, punctate midline myelotomy was introduced around the world as a new surgical procedure for the treatment of visceral pain residual to cancer and refractory to conventional treatment.^{[citation needed]}

External links

Al-Chaer ED et al. A role for the dorsal column in nociceptive visceral input into the thalamus of primates. J Neurophysiol. 1998 Jun;79(6):3143-50
Laboratory of Elie D. Al-Chaer for the Study of Pain
Science News Online (2/13/99): Pain, Pain, Go Away
A CBS HealthWatch: Breakthrough In Battling Back Pain, New Procedure Just 8 Minutes To Change Your Life

References

^ Mann, Michael. "Somesthesia - Central Mechanisms". The Nervous System in Action. Retrieved 30 May 2011.

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English Journal

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Yang A1,2, Brown J1,3, Mak E1,4.
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Sympathetic blocks for visceral cancer pain management: A systematic review and EAPC recommendations.

Mercadante S1, Klepstad P2, Kurita GP3, Sjøgren P4, Giarratano A5; European Palliative Care Research Collaborative (EPCRC).
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Intrathecal resiniferatoxin in a dog model: efficacy in bone cancer pain.

Brown DC1, Agnello K, Iadarola MJ.
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PMID 25659068

Japanese Journal

上下腹神経叢ブロックが有効であった間質性膀胱炎の3 例

山田直人,加藤幸恵,木村丘 [他],松井秀明
日本ペインクリニック学会誌 22(1), 46-49, 2015
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NAID 130004848647

Neurolytic celiac plexus block reduces occurrence and duration of terminal delirium in patients with pancreatic cancer

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NAID 10031165388