脊髄脊椎外科における神経診察—脊髄高位診断のコツは？

Tips for Neurological Examinations in Spinal Surgery

Point

・脊髄脊椎外科の魅力は，正しい診断と手術により患者の症状を劇的に改善できることにある．

・画像を直すのではなく，患者を治す．そのために，神経診察により患者症状の責任病変を絞り込むことが大切である．

・画像所見はあくまでも神経診察による診断を確認するために使用する．その際，同一椎間板レベルにおける神経根と脊髄髄節レベルの「ずれ」に注意する．

・患者の訴えを聴き，姿勢や動きによる症状の変化に注目する．

　The appeal of spinal surgery is that it can dramatically improve patients' symptoms. To achieve this goal, establishment of preoperative diagnosis based on neurological examination is important.

　In this article, we will outline some tips for neurological examination in spinal surgery.

　The exam starts with listening to the patient's complaints. Pay attention to the patient's symptoms which change in relation to posture or movement. The muscle strength tests, sensory exams, and deep tendon reflex testing should follow. It would be fascinating if your examination skills were good enough to identify the responsible lesion causing the patient's symptoms without referring to the MRI. Neurosurgeons will be able to enjoy blissful moments with their patients, if the patients are relieved from pain or other symptoms after surgery.