Most cordotomies utilize the percutaneous approach at the level of C1-C2. The surgeon often uses fluoroscopic or CT guidance. Patients are usually awake for the procedure which is performed under local anesthesia. A laminectomy is required to execute an open cordotomy. It comes with a lengthier recovery and a higher risk of side effects. However, when percutaneous cordotomy is unfeasible, especially in children, the open procedure is preferred.[6]

Only a few experiences serious post-procedure side effects.[7]  They include dysesthesia, urinary retention, ataxia, paresis, sympathetic dysfunction (hypotension, Horner syndrome and bladder dysfunction), sexual sensitivity impaired or lost, and a form of sleep apnea (acquired central hypoventilation syndrome). The bulk of these complications result from the accidental division of the unintended reticulospinal tracts. Another serious complication is a spontaneous new pain. New pain may be old (previously extant) pain which was previously unrecognized and now unmasked by removing prior distractions. Likewise, the new pain can be viewed as an unpreventable complication from the interruption of nociceptive pathways.

Overall, the risk of severe complications with unilateral cordotomy is low. Procedure-related mortality is reported in the range of 1%-6% which is mainly due to respiratory dysfunction.[8]  With more accurate ablation techniques, no respiratory dysfunction is rare.[9]

Percutaneous cervical cordotomy is recommended for patients with a life expectancy of fewer than six months and who also meet the pain severity indications. It is a palliative procedure. Successful, immediate pain relief results in approximately three-quarters of patients.[7]   However, the rate of pain relief declines to less than 50% after two years.  As was noted earlier, new pain syndromes can also arise, unfortunately, and patients must be aware and be willing to accept that risk. As a depiction of efficacy and clinical significance and side effects, there is a study which showed diminished touch perception on the left side of the body which points to likely an anterior spinothalamic tract lesion. The nearby anterior spinocerebellar (mediating proprioception), reticulospinal (mediating autonomic outflow) and cerebrospinal (mediating voluntary movement) tracts were deemed unaffected given no signs of ataxia, autonomic issues, or motor dysfunction.[10][11]

The cordotomy is a palliative procedure. It is often performed on patients with a life expectancy under six months and comes with significant risks and with possible significant benefits. Obtaining a thorough history is essential, and questioning by the clinician should show empathy to the patient and their condition, whether it be a malignancy or other pathology.  This decision is not to be made alone or lightly by the patient, family, or a clinician. Patients must not feel rushed when having their options for intractable pain laid out before them. Furthermore, this is a surgical procedure, so interprofessional approaches to conversations must take place. The proper communication should take place between the nurse, palliative physician, the surgeon, the oncologist, and the primary physician. Each specialty should be involved with helping the patient make an informed decision which the patient feels is best for their own goals of care. As always, especially in palliative care patients with often many co-morbidities, the patient's medical history and background should be clearly defined to members of the patient's healthcare team. Any deviation from thoroughness can create significant challenges and risks for the patients, their family, and their clinicians. Medical errors are to be actively avoided. If any particular nurse or clinician feels that significant palliative procedures, such as the cordotomy, are not the best choice for the patient, they should tactfully bring up their concern to the clinicians involved in that patient's care. This approach ensures that they have a full and clear understanding of the procedure, risks, and benefits prior to approaching the patient with their professional opinion.[12]

Before cordotomy can be performed, the nurse has to make sure that the patient has understood the procedure and has signed a consent. While most cordotomies are done percutaneously, sometimes general anesthesia is required. Irrespective of how the procedure is done, patient monitoring is vital. Resuscitative equipment must be in the room before the procedure is started. Breathing and oxygen need to be continuously monitored. A nurse dedicated to the monitoring of the patient is vital.

Once cordotomy is completed, the patient's vital signs and neurological status need to be monitored. The patient may develop urinary retention that may require catheterization, apnea, and fecal incontinence. The oxygen saturation must be continually monitored until the patient is stable.