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Flat-Panel Fluoroscopy O-armGuided Percutaneous Radiofrequency Cordotomy: A New Technique for the Treatment of Unilateral Cancer Pain

Collins, Kelly L. MD; Patil, Parag G. MD, PhD

doi: 10.1227/NEU.0b013e31827415e7
Instrumentation Assessment

BACKGROUND: Percutaneous radiofrequency cordotomy (PRFC) involves controlled ablation of the anterolateral quadrant of the spinal cord, thereby relieving pain. Evolving from a morbid open surgery, the procedure has been modernized through the application of physiological target confirmation, well-regulated thermal ablation, and improved intraoperative imaging.

OBJECTIVE: To evaluate the utility in PRFC of a new high-resolution, portable flat-panel fluoroscopic imaging technology, the O-arm Imaging System. The O-arm allows traditional 2-dimensional fluoroscopy in addition to axial and 3-dimensional reconstructed computed tomography imaging.

METHODS: PRFC was performed using the O-arm Imaging System in 6 patients with unilateral cancer pain.

RESULTS: Patients experienced 90% to 100% initial pain relief, with 50% to 100% sustained pain relief at the time of death at 2 to 12 months. There were no complications.

CONCLUSION: Portable flat-panel fluoroscopy allows high-resolution, readily updated computed tomography and fluoroscopic image guidance during PRFC. Use of this new technology may assist neurosurgeons in providing an important analgesic intervention at centers possessing the imaging technology.

ABBREVIATIONS: AP, anteroposterior

PRFC, percutaneous radiofrequency cordotomy

Department of Neurosurgery, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan

Correspondence: Parag G. Patil, MD, PhD, Department of Neurosurgery, University of Michigan Hospitals and Health Centers, 3552 Taubman Health Care Center, 1500 East Medical Center Drive, SPC 5338, Ann Arbor, MI 48109-5338. E-mail:

Received May 26, 2012

Accepted August 23, 2012

Copyright © by the Congress of Neurological Surgeons