Not infrequently the neurosurgeon is confronted by a case of intractable pain distributed so high over the shoulder and neck that it cannot be interrupted by cordotomy, no matter how high the spinothalamic tract is sectioned in the cervical portion of the spine. Pain of this type is most often due to neuralgia arising in an amputation stump of the upper part of the arm or shoulder or caused by avulsion or carcinomatous infiltration of the brachial plexus or to one of the rare unexplained neuralgias which may follow an operative incision or a penetrating wound of the neck or upper part of the back. As is well known, such conditions have been most difficult to relieve, even with extensive resection of the posterior cervical sensory roots and the consequent sacrifice of a useful arm.
It has been observed clinically in patients with thrombosis of the posterior inferior cerebellar artery
WHITE JC. SPINOTHALAMIC TRACTOTOMY IN THE MEDULLA OBLONGATAAN OPERATION FOR THE RELIEF OF INTRACTABLE NEURALGIAS OF THE OCCIPUT, NECK AND SHOULDER. Arch Surg. 1941;43(1):113-127. doi:10.1001/archsurg.1941.01210130116010