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Research ArticleSpine

Cervical Cordotomy for Intractable Pain: Do Postoperative Imaging Features Correlate with Pain Outcomes and Mirror Pain?

A. Berger, M. Artzi, O. Aizenstein, T. Gonen, R. Tellem, U. Hochberg, D. Ben-Bashat and I. Strauss
American Journal of Neuroradiology April 2021, 42 (4) 794-800; DOI: https://doi.org/10.3174/ajnr.A6999
A. Berger
aFrom the Department of Neurosurgery (A.B., I.S.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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M. Artzi
bSagol Brain Institute (M.A., T.G, D.B.-B.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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O. Aizenstein
cDepartment of Radiology (O.A.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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T. Gonen
bSagol Brain Institute (M.A., T.G, D.B.-B.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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R. Tellem
dThe Palliative Care Service (R.T.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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U. Hochberg
eInstitute of Pain Medicine (U.H.)
fDivision of Anesthesiology, Tel Aviv Medical Center (U.H.), Tel Aviv, Israel
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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D. Ben-Bashat
bSagol Brain Institute (M.A., T.G, D.B.-B.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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I. Strauss
aFrom the Department of Neurosurgery (A.B., I.S.)
gSackler School of Medicine (A.B., M.A., O.A., T.G., R.T., U.H., D.B.-B., I.S.), Tel Aviv University, Tel Aviv, Israel
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  • FIG 1.
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    FIG 1.

    Manual-based segmentation of the hyperintense lesion area (blue) and the spinal cord that delineates it (gray) based on T2-weighted imaging.

  • FIG 2.
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    FIG 2.

    Postoperative MR imaging findings 1 day after cervical cordotomy. Red arrows indicate the cordotomy ablation. A, Sagittal T2-weighted imaging. B, Axial T2-weighted imaging. C and D, Axial diffusion trace images.

  • FIG 3.
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    FIG 3.

    Spearman correlation between percentage of change in BPI 1 month after cordotomy and the following values: A, Ablation size of minor axis (in-plane, axial) on diffusion trace images, (r = 0.827,P = .003). B, Major axis (sagittal) length on diffusion trace images (r = 0.705, P = .023). C, Lesion minimal MD, 10–3 mm2/s (r = −0.821, P = .004).

Tables

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    Table 1:

    Change in BPI after cordotomy and its correlation with different postoperative imaging characteristics

    % BPI Change Correlation (n = 10/15)Spearman RhoSignificance (2-Tailed)
    T2-weighted imaging total cord, %−0.091.802
    Diffusion, total cord, %0.590.073
    Major axis (sagittal), T2-weighted imaging, mm−0.529.116
    Minor axis (in-plane, axial), T2-weighted imaging, mm−0.091.802
    Major axis (sagittal), DWI, mm0.705.023
    Minor axis (in-plane, axial), DWI, mm0.827.003
    Minimal MD−0.821.004
    Maximal MD−0.091.802
    Average MD−0.450.192
    Minimal FA−0.148.688
    Maximal FA0.255.476
    Average FA0.292.413
    • View popup
    Table 2:

    Imaging characteristics of patients with and without immediate postoperative contralateral pain

    POD 1 Contralateral PainYes 5/15No 10/15Sig.
    Pain side, right, n (%)2 (40%)6 (60%).608
    T2-weighted imaging total cord, %17.46 ± 10.2720.10 ± 7.91.270
    Diffusion, total cord, %14.60 ± 7.6015.67 ± 9.65.999
    MD0.804 ± 0.981.019 ± 0.222.037
    FA0.402 ± 0.070.408 ± 0.073.903
    • Note:—Sig indicates significance.

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American Journal of Neuroradiology: 42 (4)
American Journal of Neuroradiology
Vol. 42, Issue 4
1 Apr 2021
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A. Berger, M. Artzi, O. Aizenstein, T. Gonen, R. Tellem, U. Hochberg, D. Ben-Bashat, I. Strauss
Cervical Cordotomy for Intractable Pain: Do Postoperative Imaging Features Correlate with Pain Outcomes and Mirror Pain?
American Journal of Neuroradiology Apr 2021, 42 (4) 794-800; DOI: 10.3174/ajnr.A6999

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Cervical Cordotomy for Intractable Pain: Do Postoperative Imaging Features Correlate with Pain Outcomes and Mirror Pain?
A. Berger, M. Artzi, O. Aizenstein, T. Gonen, R. Tellem, U. Hochberg, D. Ben-Bashat, I. Strauss
American Journal of Neuroradiology Apr 2021, 42 (4) 794-800; DOI: 10.3174/ajnr.A6999
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