Somatotopy and Organization of Spinothalamic Tracts in the Human Cervical Spinal Cord.
Adult
Aged
Cancer Pain
/ surgery
Cervical Cord
/ anatomy & histology
Cordotomy
/ methods
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pain Threshold
/ physiology
Pain, Intractable
/ surgery
Spinal Cord
/ surgery
Spinothalamic Tracts
/ anatomy & histology
Tomography, X-Ray Computed
/ methods
Cancer pain
Cordotomy
Magnetic resonance imaging
Quantitative sensory testing
Spinothalamic tracts
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 06 2019
01 06 2019
Historique:
received:
01
12
2017
accepted:
20
06
2018
pubmed:
17
7
2018
medline:
2
4
2020
entrez:
17
7
2018
Statut:
ppublish
Résumé
Understanding spinothalamic tract anatomy may improve lesioning and outcomes in patients undergoing percutaneous cordotomy. To investigate somatotopy and anatomical organization of spinothalamic tracts in the human cervical spinal cord. Patients with intractable cancer pain undergoing cordotomy underwent preoperative and postoperative quantitative sensory testing for sharp pain and heat pain on day 1 and 7 after cordotomy. Intraoperative sensory stimulation was performed with computed tomography (CT) imaging to confirm the location of the radiofrequency electrode during cordotomy. Postoperative magnetic resonance (MR) imaging was performed to define the location of the lesion. Twelve patients were studied, and intraoperative sensory stimulation combined with CT imaging revealed a somatotopy where fibers from the legs were posterolateral to fibers from the hand. Sharpness detection thresholds were significantly elevated in the area of maximum pain on postoperative day 1 (P = .01). Heat pain thresholds for all areas were not elevated significantly on postoperative day 1, or postoperative day 7. MR imaging confirmed that the cordotomy lesion was in the anterolateral quadrant, and in this location the lesion had a sustained effect on sharp pain but a transient impact on heat pain. In the high cervical spinal cord, spinothalamic fibers mediating sharp pain for the arms are located ventromedial to fibers for the legs, and these fibers are spatially distinct from fibers that mediate heat pain.
Sections du résumé
BACKGROUND
Understanding spinothalamic tract anatomy may improve lesioning and outcomes in patients undergoing percutaneous cordotomy.
OBJECTIVE
To investigate somatotopy and anatomical organization of spinothalamic tracts in the human cervical spinal cord.
METHODS
Patients with intractable cancer pain undergoing cordotomy underwent preoperative and postoperative quantitative sensory testing for sharp pain and heat pain on day 1 and 7 after cordotomy. Intraoperative sensory stimulation was performed with computed tomography (CT) imaging to confirm the location of the radiofrequency electrode during cordotomy. Postoperative magnetic resonance (MR) imaging was performed to define the location of the lesion.
RESULTS
Twelve patients were studied, and intraoperative sensory stimulation combined with CT imaging revealed a somatotopy where fibers from the legs were posterolateral to fibers from the hand. Sharpness detection thresholds were significantly elevated in the area of maximum pain on postoperative day 1 (P = .01). Heat pain thresholds for all areas were not elevated significantly on postoperative day 1, or postoperative day 7. MR imaging confirmed that the cordotomy lesion was in the anterolateral quadrant, and in this location the lesion had a sustained effect on sharp pain but a transient impact on heat pain.
CONCLUSION
In the high cervical spinal cord, spinothalamic fibers mediating sharp pain for the arms are located ventromedial to fibers for the legs, and these fibers are spatially distinct from fibers that mediate heat pain.
Identifiants
pubmed: 30011044
pii: 5053335
doi: 10.1093/neuros/nyy330
pmc: PMC6702412
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E311-E317Subventions
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA200263
Pays : United States
Informations de copyright
Copyright © 2018 by the Congress of Neurological Surgeons.
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