Table 5

Summary of adverse events and details of deaths following cordotomy

Author, year
Number of participants*
Procedure specificGeneralDetails of deaths following (not necessarily due to) cordotomy
Antrobus 2011
N=8
n=3
‘No patient suffered neurological complication or other lasting harm’
Crul et al25 2005
N=43
n=4
Mirror pain in one (1/4, 25%) patient, transient, with minimal impact on well-being
Jackson et al22 1999
N=53
n=53
Dysaesthesia in two patients (2/53, 3.77%)
Persistent motor weakness in four patients (4/53, 7.55%), in one graded as MRC 4/5; in three ‘not regarded as severe’, no data on duration of weakness, no hemiplegia or inability to walk
No incontinence due to sphincter disturbance, no impotence or postural hypotension
Chest infection with pyrexia in two patients (2/53, 3.77%)Six deaths within 2 weeks of procedure, five had successful procedures; three within 1 week, three within 2 weeks; none had a second procedure
Two died due to presumed chest infections
Two ‘severely disabled by dyspnoea at rest because of pleural encasement from their tumours’
One had ‘marked cachexia and a very short life expectancy due to the mesothelioma itself’
No information available regarding sequence of events leading to death in one patient
Kanpolat et al23 2002
N=19
n=19
Dysaesthesia in one patient (1/19, 5.26%)‘No mortality due to procedure’
Seven died ‘due to progression of malignancy’
Nicosia et al21 1983
N=20
n=3
POOLED DATA
Urine retention in one (1/20, 5%) case resolved within 4 days after repeated catheterisations
‘Weakness–ataxia’ in seven cases (7/20, 35%) resolved spontaneously in 2–7 days
Respiratory failure in one case (1/20, 5%) ‘needed assistance’
Postoperative hypotension in one case (1/20, 5%) resolved with sympathomimetics in 2–3 h
All complications were post-surgical and temporary
Price et al17 2003
N=37
n=32
POOLED DATA
Ipsilateral leg weakness in three (3/37, 8.11%) patients, MRC 4/5, resolved after physiotherapy at 2 -week follow-up
‘No significant change in FEV1.0 at 24 h or 2 weeks’ (mean=1.5 L baseline, 1.5 L at 24 h, 1.6 L at 2 weeks)
‘No significant change in FVC at 24 h or 2 weeks’ (mean=1.9 L baseline, 2.0 L at 24 h, 2.14 L at 2 weeks), ‘Improvement in FVC immediately’ in 16 patients (16/35, 45.71%), ‘mean FVC improved by 13% at 2 weeks’ (mean=1.9–2.14 L)
‘Improvement in FVC immediately’ in 16 patients, ‘mean FVC had improved by 13% at 2 weeks’ (data on 18 patients)
‘mean PEFR was reduced’ at 24 h(315 l/min to 247 l/min), ‘but had returned to baseline values at 2 weeks’
‘Mean partial pressures for oxygen and carbon dioxide did not alter from baseline significantly’ (mean PaO2=10.3 kPa baseline, 10.7 kPa at 24 h) (mean PaCO2=5.1 kPa baseline, 5.2 kPa at 24 h)
Confusion in three patients (3/35, 8.57%) improved after 24 h
Worsening of left ventricular failure following a blood transfusion in one patient (1/35, 2.86%)
‘No patients experienced postoperative pneumonia’
Four early deaths (3–14 days)
Two due to ‘cerebrovascular accidents’
Two due to ‘advanced thoracic malignancy’
No relationship between the maximum height of the blockade as defined by pinprick testing and survival
Raslan(b)24 2005
N=8
n=5
No reports of sleep-induced apnoea syndrome at 24 hNo complications reported
Raslan(a)14
2008
N=41
n=24
POOLED DATA
All complications were ‘transient and not severe’
Dysaesthesia in two (2/41, 4.88%) patients: in one it persisted for 3 days and in the other for 2 weeks
Hypotension in two cases (2/41, 4.88%), but resolved after parenteral intravenous fluid administration, patients discharged without event
Headaches in three patients (3/41, 7.32%) resolved after treatment with analgesics and fluids for 48 h, patients discharged without event
No reported complications of weakness/change in motor power, sleep apnoea or respiratory depression
Sharma 2011
N=35
n=17
At 2 days: headaches in 10 cases (10/17, 58.82%), mirror pain in 3 (3/17, 17.65%), no adverse events in 4
At 28 days: ‘nerve damage’ in 1 case (1/17, 5.88%), mirror pain in 2 (2/17, 11.76%), no adverse events in 14
  • *N=Number of patients in the study (all diagnoses) where the intention was to perform cordotomy; n=number of patients with a diagnosis of mesothelioma where the intention was to perform cordotomy.

  • FEV 1.0, forced expiratory volume in 1 sec; FVC, forced vital capacity; MRC, Medical Research Council Scale for Grading Muscle Function; PEFR, peak expiratory flow rate.