Background & Aims
Cordotomy is an established procedure for controlling cancer pain. Since the percutaneous cervical technique requires patient collaboration, open thoracic cordotomy becomes the viable alternative for pediatric patients. In a case of open cordotomy in a child with pain in the lower limb, the size of the lesion and the single characteristics of the procedure in this age group were questioned. In the literature, three rare cases of cordotomy in children were found. However, we didn’t find information regarding the technique and variations depending on the age group. We also didn’t find anatomical or radiological studies of the transverse diameter of the spinal cord at the thoracic level in children. The final goal of this study was to evaluate spinal cord diameter in the pediatric population of different ages to estimate the lesion size necessary for pain control.
Methods
We selected forty-eight magnetic resonances of the thoracic spine at levels from T1 to T4 of patients between 0 and 12 years of age. The T2 Fast-Spin Echo sequence was used to millimetrically evaluate the spinal cord’s transverse diameter (TD) at levels most used in open cordotomy.
Results
The results revealed a progressive spinal cord growth tendency up to seven years of age. From the eighth year onwards, this growth slows down, approaching the values of the adult age group, with 10±1mm of TD.
Various factors are known to affect cordotomy efficiency and safety. Size has always been leading, making neurosurgeons throughout history walk a fine line between failure to cease the pain or causing unwanted side effects. As the size of the medulla correlates directly with the tract’s distance from the surface and extension of the lesion, possible variations we might encounter in the pediatric population undergoing cordotomy must be considered. Traditional adult lesions range from 3 to 5 mm deep in the anterolateral quadrant of the spinal cord in open cordotomy, associating cold blade and blunt dissection at a depth of 4 mm. In our study, we observed a reduction of approximately 20% in the transverse diameter of the thoracic medulla in children under seven. Therefore, it is understandable that the size of the incision by cold lamina of the spinal cord should be adapted to 3.2 mm to avoid lesions associated with contralateral or posterior cord violation, depending on the approach.
Conclusions
Based on the results that the thoracic spinal cord thoracic transverse diameter becomes equivalent to that of the adult patient by eight years of age, we suggest maintaining the surgical technique for this age group. However, under seven years, we propose a reduction in the lesion size by at least 0.8mm, establishing a range between 2.4mm to 4mm in the final incision depth.
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References
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Presenting Author
Gustavo Lages
Poster Authors
Topics
- Pain in Special Populations: Infants/Children