Complications of percutaneous cordotomy

Percutaneous cordotomy is a procedure in which the spinal anterolateral ascending system for the transmission of nociception, known as the spinothalamic tract, is interrupted to relieve pain. Under computed tomography guidance, the needle is positioned so that its tip is directed to the anterior portion of the spinal cord. The major permanent complications of percutaneous cordotomy include loss of temperature sensation, mirror pain, headache, urinary complications, respiratory complications, Horner syndrome, epidural hematoma and post-cordotomy dysesthetic syndromes. Paresis may occur ipsilateral to the lesion, due to the effect of cord edema on the corticospinal tracts. Practitioners who perform cordotomy should be aware of patients' history of anticoagulation. Emergency decompression of epidural hematoma has to be performed in patients who are neurologically deteriorating. Transient hypotension can be seen following cordotomy. This is generally resolved by normal saline infusion. © 2022 John Wiley & Sons Ltd. All rights reserved.