Structural Connectivity Enhanced Anisotropic 3D Network for Brain Midline Delineation

Brain midline delineation can facilitate the clinical evaluation of brain midline shift,which has a pivotal role in the diagnosis and prognosis of various brain pathology.However,there are still challenges for brain midline delineation:1)the largely deformed midline is hard to localize if mixed with severe cerebral hemorrhage;2)the predicted midlines of recent methods are not smooth and continuous which violates the structural priority.To overcome these challenges,we propose an anisotropic three dimensional(3D)network with context-aware refinement(A3D-CAR)for brain midline modeling.The proposed network fuses 3D context from different two dimensional(2D)slices through asymmetric context fusion.To exploit the elongated structure of the midline,an anisotropic block is designed to balance the difference between the adjacent pixels in the horizontal and vertical directions.For maintaining the structural priority of a brain midline,we present a novel 3D connectivity regular loss(3D CRL)to penalize the disconnectivity between nearby coordinates.Extensive experiments on the CQ dataset and one in-house dataset show that the proposed method outperforms three state-of-the-art methods on four evaluation metrics without excessive computational burden.

The Application of Midline Catheter in Perioperative Period of Patients with Laryngopharyngeal Cancer

Objective: To investigate the application value of midline catheters in patients with larynx cancer during the postoperative period. Methods: 150 patients with larynx cancer treated in our hospital from May 2019 to May 2022 were selected as the study objects. According to the random number method, 75 cases were divided into a control group and a study group. The study group used a midline catheter during treatment, and the control group used a Peripheral venous indwelling needle during treatment. The indwelling time, puncture times, complication rate, daily catheter maintenance cost and catheterization satisfaction rate of the two groups were compared. Result: The retention time of the study group (11.53 ± 6.91 days) was significantly higher than that of the control group (2.92 ± 1.41 days) (P . The total puncture times were significantly lower than that of the control group (P cidence of complications such as catheter blockage, catheter detachment, drug extravasation and phlebitis were lower than those of the control group. The difference was statistically significant (P < 0.05), the average daily maintenance cost of the two groups was not statistically significant (P > 0.05), and the satisfaction rate of the study group was significantly higher than that of the control group, the difference was statistically significant (P Conclusion: Compared with the Peripheral venous indwelling needle, postoperative application of a midline catheter in patients with larynx cancer can effectively reduce the number of puncture times and the incidence of catheter-related adverse reactions, and has higher economic benefits and satisfaction rate, which is worthy of clinical application.

Two-Year Outcomes of Midline lumbar Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of L4-L5 Degenerative Disease

Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.

Midline synovial and ganglion cysts causing neurogenic claudication

Typically situated posterolateral in the spinal canal, intraspinal facet cysts often cause radicular symptoms. Rarely, the midline location of these synovial or ganglion cysts may cause thecal sac compression leading to neurogenic claudication or cauda equina syndrome. This article summarizes the clinical presentation, radiographic appearance, and management of three intraspinal, midline facet cysts. Three patients with symptomatic midline intraspinal facet cysts were retrospectively reviewed. Documented clinical visits, operative notes, histopathology reports, and imaging findings were investigated for each patient. One patient presented with neurogenic claudication while two patients developed partial, subacute cauda equina syndrome. All 3 patients initially responded favorably to lumbar decompression and midline cyst resection; however, one patient required surgical stabilization 8 mo later. Following the three case presentations, we performed a thorough literature search in order to identify articles describing intraspinal cystic lesions in lateral or midline locations. Midline intraspinal facet cysts represent an uncommon cause of lumbar stenosis and thecal sac compression. Such entities should enter the differential diagnosis of midline posterior cystic lesions. Midline cysts causing thecal sac compression respond favorably to lumbar surgical decompression and cyst resection. Though laminectomy is a commonly performed operation, stabilization may be required in cases of spondylolisthesis or instability.

Midline Prostatic Cysts Presenting with Chronic Prostatitis or Secondary Infertility and Minimally Invasive Treatment: Endoscopic or Laparoscopic Approach?

Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has little effect on the large cysts and cysts lying deeply, in contrast with the laparoscopic approach. Therefore, the selection of minimally invasive therapeutic approaches is important. The aim of this study is to describe our experience in the diagnosis and selection of minimally invasive treatment for midline prostatic cyst. Methods: 15 cases of midline prostatic cyst were studied.10 cases presented with prostatitis-like symptoms, 1 with dysuria and acute urinary retention, 3 with secondary infertility and the rest 1 with hemospermia. 6 patients presented with small cysts (≤2 cm × 2 cm) close to urethra and underwent transurethral unroofing. The other 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate received the laparoscopic excision. Results: The average duration of transurethral unroofing and laparoscopic excision was 39 mins and 118 mins respectively, whereas the average time of hospitalization was 2.7 days and 4.5 days respectively. After a follow-up of 21 months, all cases were treated successfully without complications and recurrence. Their prostatitis-like symptoms disappeared, and the three patients presented with secondary infertility achieved conception within one year after the operation. Conclusions: A midline prostatic cyst can present with chronic prostatitis-like symptoms and secondary infertility. It can be cured by minimally invasive treatments, but these procedures should be carefully selected according to the size and location of the cyst.

Application of Midline Catheter in Patients with Oral Cavity Malignancies during Perioperative Period

Objective: The study aims to compare the application value of midline catheter and indwelling needle in patients with oral cavity malignancies during perioperative period. Methods: 146 patients with oral cavity malignancies admitted to our hospital from January 2019 to July 2021 were selected as the research subjects. 73 patients treated with midline catheters during the treatment were the experimental group, and another 73 patients were treated with indwelling needles as the control group. The indwelling time, total number of puncturing times, and incidence of adverse reactions of two catheterization methods were compared between the two groups. Meanwhile, each patient was investigated for treatment satisfaction. Result: The indwelling time was significantly longer in the experimental group than in the control group (P < 0.0001), and the total number of puncturing times in the experimental group was significantly lower than that in the control group (P < 0.0001). The incidence of adverse reactions in the experimental group (χ2 = 4.960, P = 0.0259) was significantly lower than that in the control group in terms of catheter occlusion (χ2 = 12.56, P = 0.0004), catheter detachment (χ2 = 8.46, P = 0.0036), drug extravasation (χ2 = 3.27, P = 0.0011), phlebitis (χ2 = 3.62, P = 0.0003), and bleeding from the puncture point (χ2 = 14.98, P = 0.0001). The satisfaction rate (χ2 = 33.45, P < 0.0001) and fundamental satisfaction rate (χ2 = 16.57, P < 0.0001) in the experimental group were significantly higher than those in the control group, while the dissatisfaction rate was significantly lower than that in the control group (χ2 = 11.38, P = 0.0007). The difference is statistically significant. Conclusion: Compared with indwelling needle, the application of midline catheters in patients with oral cavity malignancies during perioperative period can effectively reduce the number of puncturing times and the incidence of catheter-related adverse reactions, with a high satisfaction rate, which is worthy of clinical promotion and application.

Nuclear Protein in Testis Midline Carcinoma Simulating Germ Cell Tumor of the Mediastinum

Nuclear protein in testis (NUT) midline carcinoma (NMC) is a very rare and aggressive human cancer characterized by overexpression of the nuclear protein in testis (NUT) most commonly due to a chromosomal translocation that fuses the NUT gene on chromosome 15 with the BRD4 gene on chromosome19. It has been described mainly in younger individuals in the mediastinum and head and neck regions and known to be highly aggressive with poor outcomes. We report the case of 23 years old male, diagnosed with locally advanced mediastinal malignancy metastatic to the lung with elevated serum alpha-fetoprotein (AFP) suggestive of germ cell tumor. However, pathology with immunohistochemistry excluded the dignosis of germ cell tumor and confirmed the diagnosis of poorly differentiated carcinoma. Despite aggressive treatment, evolution was marked by rapid clinical deterioration leading to death within 1 month of initial diagnosis. We report this case to underline the rarity of this disease, clinico-radiological and pathologic features, especially misleading presentation with germ cell tumors, treatment management and prognosis.

Ideal Midline Detection Using Automated Processing of Brain CT Image

Brain ideal midline estimation is vital in medical image processing, especially in analyzing the severity of a brain injury in clinical environments. We propose an automated computer-aided ideal midline estimation system with a two-step process. First, a CT Slice Selection Algorithm (SSA) can automatically select an appropriate subset of slices from a large number of raw CT images using the skull’s anatomical features. Next, an ideal midline detection is implemented on the selected subset of slices. An exhaustive symmetric position search is performed based on the anatomical features in the detection. In order to enhance the accuracy of the detection, a global rotation assumption is applied to determine the ideal midline by fully considering the connection between slices. Experimental results of the multi-stage algorithm were assessed on 3313 CT slices of 70 patients. The accuracy of the proposed system is 96.9%, which makes it viable for use under clinical settings.

NUT midline carcinoma as a mediastinal tumor treated with cisplatin: A case report

NUT(nuclear protein of the testis)midline carcinoma(NMC)is a rare malignant and poorly differentiated squamous cell tumor that typically presents in midline structures of the head,neck and mediastinum with high degree of invasion and mortality,which occurs at any age,especially in teenagers and young people.We report a case of NMC presented as a mediastinal tumor.A 14-year-old female patient who presentedwith progressive dyspnea,cough with expectoration,and right pleural effusion and mediastinal space-occupying.Cisplatin(DDP)-based chemotherapy was performed.The prognosis is bad with an overall survival of 3 months.

Transoral robotic surgery vs.endoscopic partial midline glossectomy for obstructive sleep apnea

Objective:To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.Methods:This was a retrospective study.A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery.Patients were excluded for indications other than sleep apnea or if complete sleep studies were not obtained.Thus,45 robotic and 16 endoscopic surgeries were included in the analysis.Results:In the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h-(14.0 ± 3.0) events/h,P ＜ 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9,P ＜ 0.001),and O2 nadir (82.0％ ± 6.1％ to 85.0％ ± 5.4％,P ＜ 0.001).In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9,P =0.06),Epworth Sleepiness Scale (12.6 ± 5.5 to 8.3 ± 4.5,P =0.08),and O2 nadir (80.2％ ± 8.6％ to 82.7％ ± 6.5％,P =0.4).Surgical success rate was 75.6％ and 56.3％ in the robotic and endoscopic groups,respectively.Greater volume of tissue removed was predictive of surgical success in the robotic cases (10.3 vs.8.6 ml,P =0.02).Conclusions:Both robotic surgery and endoscopic techniques for tongue base reduction improve objective measures of sleep apnea.Greater success rates may be achieved with robotic surgery compared to traditional methods.

RADIOTHERAPY OF MIDLINE MALIGNANT RETICULOSIS

The results of radiotherapy made on 23 patients with midline malignant reticulosis showed that the 1 , 3-, 5- and 8-year survival rates were 91.3%, 63.2%, 50.0% and 40.0%, respectively. The optimum radiation dose was 50-60 Gy / 5-6 weeks. Chemotherapy with CCNU following the radiotherapy facilitated the healing of lesion, reduced local recurrence and distant metastasis, improved the therapeutic effect and raised the survival rate.

Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.

Exploratory therapy for brainstem gliomas

Brainstem gliomas comprise both slow-growing and highly aggressive tumors,the latter carrying a dismal prognosis of approximately 10 months in children.Given their common locations along the brainstem,they are often not amenable to surgical resection.There are currently a host of exploratory therapies under investigation ranging from immunotherapy,small molecular inhibitors,epigenetic-modifying agents,and radiation protocols to combat these difficult-to-treat tumors.Recent discoveries highlighting the role of H3 histone mutations in diffuse midline glioma oncogenesis have yielded a variety of new targetable antigens and aberrant signaling pathways.Although many of these studies have shown promise in terms of inhibiting tumor growth and disease progression,results to date have been modest in their ability to translate into meaningful clinical benefit.This review will serve as an updated report on the current state of literature concerning pre-clinical and clinical therapies being investigated for brainstem glioma.In addition,this review will serve as a guide for clinicians as we review the evolving nomenclature of brainstem gliomas,commonly presenting symptoms,diagnostic tools,and standard therapies.

基于时空关系的盾构开挖地表沉降规律

基于武汉地铁四号线某区间隧道盾构开挖引起的地表沉降数据分析,考虑地表沉降的时空关系,将地表沉降划分为无影响阶段、前期沉降阶段、通过阶段、盾尾空隙沉降阶段、工后沉降阶段,并给出了各个阶段的大致范围及其地表沉降占总沉降的比值。通过对Mindlin解引入时间参数,针对不同阶段地表沉降影响因素进行分析,在前影响距离范围内,盾构机与土体的摩擦力和地层损失对地表沉降的影响占优,在后影响距离范围内,地层损失对地表沉降起到了绝对的控制作用,前期沉降阶段的土层隆起与正面附加推力、摩擦力有关,而正面附加推力、摩擦力和注浆压力导致了工后沉降阶段的土体回弹,由此获得了实时地表沉降预测的理论公式。研究结果表明:理论预测值与实测值能较好的吻合,该公式能够较为准确地实时预测地表沉降。

Extreme temperature increases the severity of intracerebral hemorrhage: An analysis based on the cold region of China

Objective:The purpose of this study was to find a suitable model to evaluate the relationship between temperature and intracerebral hemorrhage(ICH)and explore the effects of cold spells and heat waves on the clinicopathological parameters of ICH patients.Methods:We conducted a retrospective study based on the ICH admission in the First Affiliated Hospital of Harbin Medical University from 2015 to 2020(N=11124).The relationship between different seasons and the number of patients with ICH was explored.Poisson Akaike information criterion(AIC)was used to select the optimal model for temperature and ICH.Binary logistic regression analysis was used to investigate the association between extreme temperatures and clinicopathological features.Results:Hospital admissions for patients with ICH showed monthly changes.The optimal cold spell was defined as the daily average temperature<3rd percentile,lasting for five days,while the optimal heat wave was defined as the daily average temperature>97th percentile,lasting for three days.Based on the generalized extreme weather model,cold climate significantly increased the risk of hematoma volume expansion(OR 1.003;95%CI:1.000-1.005,P=0.047).In the optimal model,the occurrence of cold spells and heat waves increased the risk of midline shift in both conditions(OR 1.067;95%CI:1.021-1.115,P=0.004;OR 1.077;95%CI:1.030-1.127,P=0.001).Conclusion:Our study shows that seasonal cold spells and heat waves are essential factors affecting ICH severity,and targeted preventive measures should be taken to minimize the pathological impacts.

Repair of the Median Microform Cleft Lip Using Z-Plasty

A median cleft lip is a rare central midline deficiency of the upper lip. Multiple surgical techniques are described in the literature to address this defect, though there is little consensus on the preferred surgical technique. We describe an intra-oral approach for repair of the median upper lip cleft using mucosal Z-plasty. This technique provides excellent access to the attenuated orbicularis oris muscle and the frenulum fibrosed to the labial margin. The tethered lip can be mobilized and the notch converted with appropriate mucosal length, lip height, and vermillion fullness. The contour of the free labial border immediately improves, all while avoiding a cutaneous scar. The midline cleft lip notch can be effectively treated by adhering to 3 major principles: 1) excision of the tight, constrictive labial band;2) achieving midline orbicularis oris muscle approximation;and 3) establishing mucosal lengthening using a Z-plasty.

Management of 634 Consecutive Patients with Chronic Pilonidal Sinus: A Nine-Year Experience of a Single Institute

Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.

New-Fangled Slowly-Absorbable versus Non-Absorbable Sutures for Abdominal Fascial Closure. Have the Goals towards an Advantageous Suture Been Met?

Background-Aim: The technique of abdominal closure along with the material to be used is constantly evolving. The aim of the present study is to evaluate differences in midline laparotomy closure with a standard closure technique and new-fangled slow-absorbable versus non-absorbable sutures. Material and Methods: A prospective, comparative study of patients undergoing laparotomy closure with either STARDIOX (Polydioxanone) or STARLENE (Polypropylene) sutures during a 9 month period was performed. Patients were evaluated and compared in terms of surgical site infection, incisional hernia, burst abdomen, and suture sinus formation. Results: A total of 284 patients were included [141 in the STARDIOX (Polydioxanone) group and 143 in the STARLENE (Polypropylene) group]. Sinus formation was not noticed and no palpable knots were reported in both groups. Moreover burst abdomen was never encountered. Incisional hernia rates were similar for both suture materials: n = 6 (4.3%) for the STARDIOX (Polydioxanone) group and n = 5 (3.5%) for the STARLENE (Polypropylene) group. There was not statistically significant relationship between the type of suture that was used and wound infection: n = 5 (3.5%) in the STARDIOX (Polydioxanone) group and n = 6 (4.2%) in the STARLENE (Polypropylene) group. Complications did not occur in 96.1% of all patients. Conclusions: Our study suggests that there are no significant differences between these two new-fangled sutures. It seems that progress of suture materials has led to a step towards the goals of a beneficial suture and from then on complications of surgical wound closure should be merely a matter of operative technique.

Retrospective Evaluation of the Prevalence of Diastema among an Adult Population

Purpose: With the increased demand for orthodontic treatments in adults, Diastemas have always been an obstacle for either pre or post orthodontic treatment. The purpose of the present investigation is to identify the prevalence and location of diastema among patients attending the dental clinics, School of Dental Medicine, University of Nevada, Las Vegas (UNLV). Methods: A retrospective keywords search of the clinical notes of UNLV School of Dental Medicine (SDM) patient charts in AxiUmTM (dental practice management software) was performed using the search terms “diastema” and “midline diastema” to identify the number of cases that clinically presented with diastema from 1/1/2014-9/30/2020. Demographic data were then analyzed using a Chi-square test and compared against Clark County population data. Results: 1182 patients’ records were identified to have one of the search keywords. 56.7% of the patients who presented with diastema were female, 43.1% were male and 0.2% were transgender. 31.5% of patients presenting with diastema were between the ages of 12 and 19. The majority of the diastema cases were in maxillary teeth, followed by diastema in both maxillary and mandibular. The least number of cases had only mandibular diastema. In regards to size, most (look up percent) were mild diastema (1 - 2 mm), followed by moderate (2 mm) and severe (above 2 mm). The reported ethnicity with highest diastema was Hispanic followed by Caucasians and 17% were African Americans. Chi square analysis showed ethnicity results are statistically significant (p Conclusion: Ethnicity and arch are integral predictors for patients who have diastema.

Cordotomy procedures for cancer pain: A discussion of surgical procedures and a review of the literature

Treating pain in patients with terminal cancer is challenging but essential part of their care. Most patients can be managed with pharmacological options but for some these pain control methods are inadequate. Ablative spinal procedures offer an alternative method of pain control for cancer patients with a terminal diagnosis that are failing to have their pain controlled sufficiently by other methods. This paper provides a review of ablative spinal procedures for control of cancer pain. Patient selection, surgical methods, outcomes and complicationsare discussed in detail for cordotomy, dorsal root entry zone(DREZ) lesioning and midline myelotomy. Cordotomy is primarily done by a percutaneous method and it is best suited for patients with unilateral somatic limb and trunk pain such as due to sarcoma. Possible complications include unilateral weakness possibly respiratory abnormalities. Approximately 90% of patients have significant immediate pain relief following percutaneous cordotomy but increasing portions of patients have pain recurrence as the follow-up period increases beyond one year. The DREZ lesion procedure is best suited to patients with plexus invasion due to malignancy and pain confined to one limb. Possible complications of DREZ procedures include hemiparesis and decreased proprioception. Midline myelotomy is best suited for bilateral abdominal, pelvic or lower extremity pain. Division of the commissure is necessary to address bilateral lower extremity pain. This procedure is relatively rare but published case series demonstrate satisfactory pain control for over half of the patients undergoing the procedure. Possible complications include bilateral lower extremity weakness and diminished proprioception below the lesion level. Unlike cordotomy and DREZ this procedure offers visceral pain control as opposed to only somatic pain control. Ablative spinal procedures offer pain control for terminal cancer patients that are not able to managed medically. This paper provides an in depth review of these procedures with the hope of improving education regarding these underutilized procedures.