Spinal Neuroablation for Cancer Pain

In cases of refractory cancer pain, disruption of the pain processing mechanisms of the nervous system can be helpful, an approach that may be more useful as the risks of opioid analgesia becomes more evident. There are several targets in the spinal cord that are available for an ablative procedure for pain control. Cordotomy, or interruption of the lateral spinothalamic tract, can be effective in controlling unilateral pain below the C4 dermatome. Myelotomy disconnects a dorsal midline polysynaptic visceral pain pathway and can reduce visceral, retroperitoneal, pelvic, or sacral pain. Along with other targets for neuroablation, these are important components of a successful approach to controlling cancer pain.