Somatotopy and Organization of Spinothalamic Tracts in the Human Cervical Spinal Cord

Neurosurgery
A VedantamA Viswanathan

Abstract

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 ...Continue Reading

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Citations

Dec 23, 2020·Pain Practice : the Official Journal of World Institute of Pain·Paul J W ZomersFrank J P Huygen
Mar 19, 2021·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Michal RivelRuth Defrin

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