After high cervical percutaneous cordotomy for pain in malignant disease, 12 patients died during sleep at postoperative intervals between 1 and 8 days. Nine died after a first cordotomy and three after a second (contralateral) procedure. All except one had known pulmonary disease before operation. The operated segment of the spinal cord (C2) was studied histologically after death. Superpositio...

Pain and symptom management at the end of life remains suboptimal.Pain physicians are uniquely placed to provide interventions for patients with difficult to manage pain.Interventions such as acupuncture, radiofrequency ablation, neurolysis together with regional analgesia including neuraxial techniques and spinal cordotomy may provide the patient with improved analgesia.

The techniques and results of the main percutaneous procedures performed using image guidance with computerized tomography, including cordotomy, trigeminal tractotomy-nucleotomy, and extralemniscal myelotomy, are presented. The advantages of image guidance for anatomical orientation during the procedures and the newly designed radiofrequency needle-electrode systems are stressed.