Yasuhara Takao, Sasada Susumu, Date Isao
Department of Neurological Surgery, Okayama University Graduate School of Medicine.
No Shinkei Geka. 2021 Nov;49(6):1233-1245. doi: 10.11477/mf.1436204510.
Accurate diagnosis is important for lumbar degenerative diseases. Patients' history, neurological examination, and diagnostic imaging are the three pillars for accurate diagnosis. While collecting medical history, 5W1H of the symptoms should be considered. Muscle strength, pain and numbness, and deep tendon reflex are the basic parameters in the neurological examination. A combination of the results of each tool is needed to facilitate precise diagnosis. This should be followed by diagnostic imaging to confirm the diagnosis. We feel relieved when neurological examination and diagnostic imaging reveals congruent results. The symptoms of lumbar degenerative diseases are the results of[static factors: the stenosis of the canal/intervertebral foramen]×[dynamic factor: the instability]. The T2-weighted MRI images effectively reveal canal/intervertebral foramen stenosis. Short-T1 inversion recovery(STIR)of MRI reveals early fractures and inflammation of the spine. CT findings help to imagine the process of drilling and screw insertion. A whole spine X-ray is good to reveal spinal alignment. Roentogenkymography with anteflexion/retroflexion reveals the instability of the lumbar spine. Myelography is effective in knowing the cerebrospinal fluid flow in a standing position. Therefore, accurate diagnosis and careful treatment are needed to obtain the appropriate outcome for a prolonged period after spinal surgery.
准确诊断对于腰椎退行性疾病很重要。患者病史、神经学检查和诊断性影像学检查是准确诊断的三大支柱。收集病史时，应考虑症状的5W1H。肌力、疼痛和麻木以及深腱反射是神经学检查的基本参数。需要综合每种检查手段的结果以促进精确诊断。随后应进行诊断性影像学检查以确诊。当神经学检查和诊断性影像学检查结果一致时，我们会感到放心。腰椎退行性疾病的症状是[静态因素：椎管/椎间孔狭窄]×[动态因素：不稳定]的结果。T2加权MRI图像能有效显示椎管/椎间孔狭窄。MRI的短T1反转恢复序列（STIR）能显示脊柱早期骨折和炎症。CT检查结果有助于设想钻孔和螺钉置入过程。全脊柱X线片有助于显示脊柱排列情况。屈伸位动态X线摄影可显示腰椎的不稳定。脊髓造影对于了解站立位时脑脊液流动情况很有效。因此，为在脊柱手术后获得长期的良好疗效，需要准确诊断并谨慎治疗。
