Clinical Observations on Respiratory and Vasomotor Disturbance as Related to Cervical Cordotomies

Abstract

F OERSTER, in 1913, first suggested the upper cervical cord as a site for cordotomy when control of pain in an upper extremity or neck was necessary. I t was not, however, until 1931 that he cautioned against a general use of bilateral high cervical cordotomy because of the impaired respiratory function that might result. He reported in 193s 7 that cordotomies in the high dorsal area were not associated with respiratory motor disturbances and concluded that the efferent tracts from the medulla oblongata to the spinal nuclei are not positioned in the anterior tracts. Since these reports, there have been numerous authors who have published their experiences with high cervical cordotomies and some divergence of views, particularly in reference to respiratory difficulties, has continued. Peer et al., TM in 1933, advised that bilateral high cervical cordotomy should not be performed because of the danger of respiratory paralysis. phrenic nerves, they said, arise chiefly from cells in the fourth cervical segment. The exact location of the tracts descending to these cell bodies is unknown. Theoretically, at least, edema following section of the anterolateral tracts might involve these descending fibers or the phrenic cells in the anterior horns as well as the motor tracts of the intercostal muscles, resulting in respiratory failure. In 1950, White and associates, 26 after reviewing their series of patients subjected to high cervical cordotomies, concluded that mortality was greater in the postoperative period when this region was used. Two of 9 deaths they reported were a result of im-