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The decussation of fibers of the spinothalamic system includes passage through the ventral white commissure of the spinal cord immediately ventral to the central canal. An oblique orientation of crossing projection fibers has been invoked to explain the disparity between the level of a spinothalamic tract lesion and the dermatomal level at which sensory deficits are detected. Currently, the rostrocaudal distribution of input from nociceptive or thermal afferents via Lissauer's tract with a transversely oriented decussation is generally accepted as the explanation for this phenomenon.
In this study of 63 anterolateral cordotomies (and one case of anterior spinal artery syndrome), these contrasting hypotheses were tested. Thermal sensation and…