Commissural myelotomy in the treatment of intractable visceral pain: Technique and outcomes

Background: Commissural myelotomy can be valuable for patients with intractable pain associated with malignancy in the abdominal or pelvic region. Methods: Between December 1992 and June 2009, 11 patients underwent commissural myelotomy at the University of Texas MD Anderson Cancer Center for the treatment of intractable lower extremity, thoracic, pelvic or sacral pain associated with unresectable tumors. The various surgical approaches to myelotomy are discussed. Results: Eight patients had excellent or good outcomes with regard to pain relief, defined as no further pain (excellent) or a significant reduction in pain and not requiring opioids stronger than codeine (good). Complications included new leg weakness (n = 3) and bladder dysfunction (n = 1). Conclusion: We found that for the properly selected patient, open midline commissural myelotomy can provide effective pain relief with acceptable postoperative morbidity.