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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/12 22:16:24」(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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UpToDate Contents

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1. 脊髄損傷および疾患の慢性合併症 chronic complications of spinal cord injury and disease
2. 帯状疱疹後神経痛 postherpetic neuralgia
3. 小児における嗄声：病因およびマネージメント hoarseness in children etiology and management
4. 早期（ステージIおよびII）の頭頸部癌の治療：喉頭 treatment of early stage i and ii head and neck cancer the larynx

English Journal

Spinal cord transection before scoliosis correction in myelomeningocele may improve bladder function.

Linthorst JI, Veenboer PW, Dik P, Pruijs HE, Han SK, de Kort LM, de Jong TP.Author information Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.AbstractAIMS: In patients with myelomeningocele (MMC) and coexistent scoliosis, a spinal cord transection (SC-transection) is sometimes performed before scoliosis correction to prevent traction on the myelum after stretching the spinal column. Performing a SC-transection may have positive effects on bladder function, especially in case of refractory detrusor-sphincter dyssynergia. This study investigates the effects of SC-transection on lower and upper urinary tract outcomes.
Neurourology and urodynamics.Neurourol Urodyn.2014 Jan;33(1):121-8. doi: 10.1002/nau.22385. Epub 2013 Feb 19.
AIMS: In patients with myelomeningocele (MMC) and coexistent scoliosis, a spinal cord transection (SC-transection) is sometimes performed before scoliosis correction to prevent traction on the myelum after stretching the spinal column. Performing a SC-transection may have positive effects on bladder
PMID 23423779

Endoscopic posterior cordotomy with microdissection radiofrequency electrodes for bilateral vocal cord paralysis.

Oysu C, Toros SZ, Tepe-Karaca C, Sahin S, Sahin-Yilmaz A.Author information Department of Otorhinolaryngology/Head and Neck Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey.AbstractThe purpose of this study is to evaluate the results of endoscopic posterior cordotomy using microdissection electrodes in patients with bilateral vocal cord paralysis. Eleven patients underwent endoscopic posterior cordotomy using a radiofrequency Arrowtip monopolar needle. Preoperative-postoperative exercise tolerance, airway, and voice evaluation were performed in all patients. Two patients required a secondary revision operation due to granulation and crust formation and respiratory problems. No other complications were encountered. Two patients with tracheotomy cannulas were decannulated on the third postoperative day. All patients had an adequate functional airway and good exercise tolerance compared with poor preoperative exercise tolerance. There was no significant difference between preoperative and postoperative Voice Handicap Index values (P > .05). The data indicated the safety, easy use, and efficiency of the microdissection radiofrequency electrodes in patients with bilateral vocal fold paralysis. This technique provides a reliable alternative to laser procedures.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.Otolaryngol Head Neck Surg.2014 Jan;150(1):103-6. doi: 10.1177/0194599813513425.
The purpose of this study is to evaluate the results of endoscopic posterior cordotomy using microdissection electrodes in patients with bilateral vocal cord paralysis. Eleven patients underwent endoscopic posterior cordotomy using a radiofrequency Arrowtip monopolar needle. Preoperative-postoperati
PMID 24357396

Radiofrequency lesioning through deep brain stimulation electrodes: a pilot study of lesion geometry and temperature characteristics.

Strickland BA, Jimenez-Shahed J, Jankovic J, Viswanathan A.Author information Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden Street, Houston, TX 77030, USA.AbstractDeep brain stimulation (DBS) electrodes have been used effectively to perform radiofrequency lesions in the brain. This study aimed to characterize lesion geometry and peak tissue temperature achieved when lesioning through DBS electrodes. Fresh bovine liver was chosen for a medium as the tissue reliably changes color between 45 and 50 °C. Medtronic 3387 DBS electrodes (Medtronic Sofamor Danek, Inc., Memphis, TN, USA) and the Cosman G4 Radiofrequency Generator (Cosman Medical, Inc., Burlington, MA, USA) were used for lesioning. Bipolar lesions were created at currents between 25 mA and 100 mA for 60-120 seconds. Peak tissue temperature was monitored with Cosman disposable cordotomy electrode (LCED; Cosman Medical Inc.) and recorded. Photographic analysis of the lesions was performed. Tissue impedance ranged between 800-900 Ohms, and tissue temperature was maintained at 20 °C. With lesions at 25 mA for up to 120 seconds, maximal tissue temperature achieved was 36 °C. This correlated with no visible lesions. At 50 mA, maximal tissue temperature exceeded 100 °C, which was associated with tissue charring. Lesions created at 35 mA and 40 mA led to an increase in tissue temperature of 63 °C and 75 °C, respectively. Lesion size was highly reproducible, increasing from 4.5 mm × 7 mm at 35 mA, to 6 mm × 7.5mm at 50 mA. Preliminary analysis suggests that caution should be exerted in using lesion amplitudes exceeding 40 mA (at 800 Ohms), as peak tissue temperatures in vivo could exceed 100 °C. Further in vivo experiments with imaging correlates are needed to further test the safety of this technique.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2013 Dec;20(12):1709-12. doi: 10.1016/j.jocn.2013.03.007. Epub 2013 Sep 13.
Deep brain stimulation (DBS) electrodes have been used effectively to perform radiofrequency lesions in the brain. This study aimed to characterize lesion geometry and peak tissue temperature achieved when lesioning through DBS electrodes. Fresh bovine liver was chosen for a medium as the tissue rel
PMID 24035651

Japanese Journal

マイクロフラップ手術

平野滋
喉頭 24(2), 90-92, 2012
… Microfalp technique consists of a superficial cordotomy, dissection of the lesion preserving healthy tissues in the lamina propria and the epithelium, removal of the lesion, and realignment of the remaining tissue. …
NAID 130003375654

Differential Diagnosis Between Intracranial Dissemination of Spinal Cord Astrocytoma and Paraneoplastic Limbic Encephalitis

Seki Morinobu,Suzuki Shigeaki,Ishii Ken,Izawa Yoshikane,Takahashi Shinichi,Toyama Yoshiaki,Nakamura Masaya,Suzuki Norihiro
Internal Medicine 51(3), 321-324, 2012
… We describe the clinical features of limbic encephalitis that developed after palliative spinal cordotomy in 2 patients with malignant thoracic astrocytoma. …
NAID 130002061969

Histologic Characterization of Human Scarred Vocal Folds

Hirano Shigeru,Minamiguchi Sachiko,Yamashita Masaru,Ohno Tsunehisa,Kanemaru Shin-ichi,Kitamura Morimasa
Journal of Voice 23(4), 399-407, 2009-07
… The present case studies aimed to define the histologic changes of scarred human vocal folds caused by cordectomy or cordotomy. … Nine patients with early glottic cancer underwent endoscopic cordectomy, and one patient underwent superficial cordotomy for idiopathic scar. … The postcordectomy or cordotomy scar was biopsied or resected 3-13 months after the original procedure. …
NAID 120001479080

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★リンクテーブル★

リンク元	「コルドトミー」「脊髄切断術」
拡張検索	「anterolateral cordotomy」「percutaneous anterolateral cordotomy」「percutaneous cordotomy」