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January 15, 1973

Sudden Death in Infants During Sleep

JAMA. 1973;223(3):330. doi:10.1001/jama.1973.03220030064033

To the Editor.—  Occasionally patients who have had bilateral high percutaneous cervical chordotomies for intractable pain die during sleep from respiratory paralysis. Mullan and Hosobuchi have reported that autopsies of three of eight patients who had high cervical percutaneous chordotomies and subsequently developed sleep-induced apnea and death following the procedure, showed complete or partial destruction of both anterior quadrants of the cervical cord.1Hitchcock and Leece have reported the somatotopic representation of the respiratory pathways in the cervical cord of man.2 Based on the depth of cuts at the C-1 and C-2 level of the cervical cord, these authors assign respiratory pathways to the reticulospinal pathways lying in the anterolateral column of the cervical spinal cord. The pathways for innervation of the intercostals are believed to be more posterior to those innervating the diaphragm, and both pathways lie in a band border on the outside of the spinothalmic