Drezotomy and Myelotomy for Cancer Pain.

BACKGROUND

When conservative treatment, including intrathecal infusion of pharmacological agents, or even multimodal therapies are not sufficiently effective, if their respective benefits-risks balances are favorable, Drezotomy and myelotomy, ablative surgeries targeting sensory circuits in the spinal cord, may still have a place today for well-selected patients.

SUMMARY: In this review article, the rationale and technical principles and their current potential indications, based on their results published, are described. Drezotomy have been reported effective for topographically limited cancer pain caused by well-localized lesion, in particular if nociceptive and neuropathic components are combined. Currently, the open punctate midline is used for patients with intractable visceral cancer pain, abdominal or pelvic, even bilateral. For patients with limited survival, percutaneous myelotomy is recommended, given the less invasive nature of the procedure. However, the technique chosen for myelotomy will ultimately depend on the surgeon's experience and expertise.

KEY MESSAGES: In spite of data coming only from case series, DREZotomy and myelotomy, that are technically demanding procedures, can be still useful interventions and discussed for well-selected patients suffering from intractable cancer pain.