Evidence for segregated pain and temperature conduction within the spinothalamic tract.
The lateral spinothalamic tract, located in the anterolateral quadrant of the white matter of the spinal cord, is one of the most important structures in transmitting pain within the central nervous system. It has been known for almost a century that destruction of fibers in this tract results in analgesia contralateral to the lesion. The effectiveness and clinical importance of interruption of the lateral spinothalamic tract has been proven in many studies. Today cordotomies are still a useful neurosurgical treatment modality, especially when pain can no longer be sufficiently controlled by analgesic drugs. Although analgesia on the contralateral side is the desired effect, one must also expect to cause disturbance in temperature sensation when performing a cordotomy. The authors' observations showed that after a cordotomy the dermatome level of analgesia can be variable within certain limits, which is in accordance with the literature. Surprisingly, however, the loss of temperature sensation may differ significantly from the loss of pain sensation. It was also found to be possible to perform a successful cordotomy without altering the sensation of temperature at all. This indicates that pain and temperature sensations may be conducted via separate pathways. Possible mechanisms underlying this phenomenon are discussed.
Friehs
G M
GM
Department of Neurosurgery, Karl Franzens Universität Graz, Austria.
Schröttner
O
O
Pendl
G
G
D000698:Analgesia / Q000379:methods; D002908:Chronic Disease; D002818:Cordotomy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000503:physiopathology*; D010148:Intractable Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013133:Spinothalamic Tracts / Q000502:physiology* / Q000601:surgery; D013697:Thermosensing / Q000502:physiology*