Effects of two unilateral cordotomies on the motility of the lower limbs

  • Nathan P
  • Smith M
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Abstract

This paper is concerned with the motor effects of two unilateral cordotomies performed for the pain of cancer. The cases presented had a unilateral cordotomy first on one side a'.d then a second cordotomy done on the opposite side of the spinal cord. In these cases, the first operation caused paresis of the ipsilateral lower limb; in time the paresis regressed and the limb recovered. The second operation, done on the other side of the cord, immediately removed all the recovery of motility that had occurred. These facts show that the recovery must have been due essentially to nerve fibres descending the spinal cord on the side contralateral to the first incision. It is likely that these facts have not been noticed before as bilateral cordotomies are not usually done in two stages. In all cases, the cordotomies were performed caudal to the cervical enlargement and in most of these cases the surgical lesions were very large. One additional case is presented in which a unilateral cordotomy was followed by an infarct destroying the internal capsule on the same side of the body as the cordotomy. This case is of value in determining which descending tracts are of importance for the recovery of motility. The relation between the lesions in the spinal cords and the reflexes and tone of the lower limbs will not be considered here, as it will be presented in a later paper, concerned with a larger number of cordotomies.

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Authors

  • P. W. Nathan

  • Marion C. Smith

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