Cordotomy, or anterolateral tractotomy, is precise and effective for the relief of pain and has a relatively low incidence of morbidity and mortality. Although the procedure is used in the treatment of certain pain problems associated with malignant conditions,1 it is infrequently considered for pain associated with benign diseases, probably because of fear of possible complications. Complications, although observed in less than 5% of patients when the procedure is performed unilaterally, include the possibility of diminished bladder control, sexual impotency, so-called postcordotomy dysesthesis, and lower-extremity weakness. Another reason for hesitation in performing cordotomy for benign conditions is that assurance of beneficial results cannot be given. Assuming that cordotomy is offered after consideration of all less hazardous methods, including rhozotomy, the patient must be willing to accept the involved risks for a 50% to 60% chance for long-term pain relief.
In otherwise normal individuals, intractable incapacitating pain must be treated