Intramedullary Spinothalamic Tractotomy

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Abstract
Section of the spinothalamic tract in the medulla was done, in 12 cases, for the relief of intractable pain of neck and upper extremities. The results throw some light on the topographical arrangement of fibers within the tract. To obtain high levels of anesthesia the cut in the medulla must be 5 mm. deep and must be extended posteriorly until the patient complains of pain on the ipsilateral side of the face. The latter sign indicates encroachment on the spinal tract and nucleus of the trigeminal nerve. These observations suggest that the spinothalamic fibers which convey impulses from the neck and upper extremity are situated in the dorsomedial portion of the spinothalamic tract in the medulla.

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