Cordotomy procedures for cancer pain: A discussion of surgical procedures and a review of the literature

Figure 1 Peripheral and central spinal pathways. Aδ: Large myelinated afferent fiber. Type A fibers don’t conduct nociception. C fibers are small unmyelinated fibers that conduct nociception. Ia and Ib fibers conduct information from muscle spindles and Golgi tendon organs, respectively. DC: Dorsal columns; STT: Spinothalamic tract.

Figure 2 The relationship between ascending pain afferents and their targets in the medulla, midbrain, thalamus and cortex.

Figure 3 A schematic illustration of percutaneous cordotomy and the relative anatomical position of the spinothalamic tract and surrounding structures. S: Sacral; L: Lumbar; T: Thoracic; C: Cervical; W: Watts.

Figure 4 A schematic illustrating dorsal root entry zone lesioning at the C8 spinal level. Rexed lamina are numbered in the typical fashion I-XIII. DREZ: Dorsal root entry zone.