頚椎疾患における痛み・痺れ領域の検討

Distribution of Pain and Numbness in Patients with Cervical Spine Disorders

Ⅰ．緒　言

　頚椎疾患においては上肢以外にも，頭部，顔面，体幹部，下肢などさまざまな領域に痛み・痺れを認め，病変の局在を予想することが困難な症状（偽性局在徴候）を含む場合も少なくない．迅速で的確な診断のためには頚椎疾患における痛み・痺れのパターンに精通する必要がある．今回，当科で頚椎疾患に対して手術を施行した連続症例における痛み・痺れ領域と，その頻度を検討した．また各領域における痛み・痺れの有無と術後神経症状の改善率の関係も検討した．

　PURPOSE:To elucidate the distribution of improved pain and numbness after cervical decompression surgery in patients with cervical spine disorders.

　METHODS:This study included 4 men and 5 women aged 45 to 71 years（mean 58 years）presenting with radiculopathy and 50 men and 17 women aged 35 to 88 years（mean 66 years）presenting with myelopathy.

　RESULTS:All 9 patients with radiculopathy presented with neck pain, and 3 presented with cervical angina. Among the patients with myelopathy, 2 presented with headache, 2 with onion-skin facial pain, 29 with neck pain, 8 with truncal pain, 7 with low back pain, 4 with numbness below the T4 dermatomal area, 1 with penile pain, 61 with arm pain, 49 with leg pain, and 2 without pain or numbness. Patients with myelopathy presenting with preoperative neck and arm pain had significantly better recovery rates compared to patients without such pain.

　CONCLUSION:Patients with cervical spine disorders present with pain and numbness in various areas. Preoperative neck pain and arm pain are indicators for better recovery in patients with myelopathy.