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1 - Discovery of the anterolateral system and its role as a pain pathway

Published online by Cambridge University Press:  05 October 2010

Frederick A. Lenz ,
Kenneth L. Casey ,
Edward G. Jones  and
William D. Willis
Frederick A. Lenz
Affiliation:
The Johns Hopkins Hospital
Kenneth L. Casey
Affiliation:
University of Michigan, Ann Arbor
Edward G. Jones
Affiliation:
University of California, Davis
William D. Willis
Affiliation:
University of Texas Medical Branch, Galveston
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Summary

Introduction

On January 19 1911, persuaded by his colleague, the neurologist William Spiller, a Philadelphia surgeon named Edward Martin made a small transverse cut in the spinal cord of a patient suffering from severe pain caused by a tumor affecting the lower end of the spinal column. The cut, made with a thin cataract knife, was no more than 2 mm deep or wide and entered the cord some 3 mm ventral to the entry of a dorsal root in the middle thoracic region. The patient experienced much relief from what had until then been intractable pain (Spiller and Martin,1912). The operation of “chordotomie” or section of the anterolateral tracts of the spinal cord had been introduced in 1910 by Schüller in work on monkeys in which he was exploring the possibility of using the operation for the alleviation of spastic paralysis and tabetic crises in humans. Spiller argued for the procedure on the basis of clinico-pathological observations that appeared to implicate the anterolateral tracts as pathways for conduction of impulses related to pain and temperature through the spinal cord (Müller, 1871; Gowers, 1879; Spiller, 1905; Petrén, 1910). Reports of other successful cases quickly followed (Beer, 1913; Foerster, 1913) and soon, at the hands of Foerster (1913, 1927; Foerster and Gagel, 1932) in Germany and Frazier (1920) in the United States, cordotomy was to become for a time the surgical method of choice in dealing with intractable pain.

Type
Chapter
Information
The Human Pain System
Experimental and Clinical Perspectives
 , pp. 1 - 63
Publisher: Cambridge University Press
Print publication year: 2010

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