脊髄脊椎外傷—診断と治療のポイントは？

Cervical Spine and Spinal Cord Injury:Keys for Diagnosis and Treatment

Point

・頭部外傷診療時の頚椎損傷スクリーニングの原則：特に飲酒時の外傷で見落としが多いことを念頭に置く．

・頭蓋頚椎移行部外傷は骨折の形態分類があり，理解することが重要である．

・中心性頚髄損傷には4つの病態があるが，その多くは高齢者の頚椎変性・脊柱管狭窄が外傷を契機に発症あるいは急激に悪化した非骨傷性頚髄損傷である．

　Spinal cord injuries are not rare in neurosurgical practice. As cervical spine injuries are frequently associated with head injuries, neurosurgeons have critical roles of immediate evaluation and treatment in an emergency room in Japan. It is crucial to make a correct initial diagnosis and provide appropriate treatment for cervical spine injuries because missed injuries or delayed diagnosis might result in unwarranted neurological sequelae. This paper focuses on tips regarding 1）screening for cervical spine injury in head injury patients, 2）diagnosis and treatment of cranio-vertebral junction injuries, and 3）diagnosis and treatment of acute traumatic central cord syndrome because these conditions are most likely encountered by neurosurgery residents and fellows in their practice.