The possible causes of false localizing signs on lumbar spine: a case presentation and literature review

Based on a patient's presentation, careful neurologic examinations and radiographic data may be employed to identify pathological lesions. From a surgical standpoint, the laterality of lesions always influences surgical planning and results. Precise localization is crucial for the success of the commonly preferred minimally invasive surgeries. False localization can undercut such efforts. Even though we strive to confirm lesions before operating, false localization may still occur. In this report, we present a case of a patient with false localizing signs on the lumbar spine. The signs of localization of lumbar radiculopathy differed between presenting symptoms and magnetic resonance imaging scans. This discrepancy posed difficulties in deciding on the surgical approach. There were no published case reports on false localization signs at the lumbar spine before. In this report, we discuss the possible mechanisms involved and review the relevant literature.

關鍵字

false localizing signs ； lumbar spine ； Kernohan-Woltman notch phenomenon ； minimally invasive surgery

並列摘要

根據患者的臨床表現、仔細的神經學及影像學上的檢查可以很容易將病灶在病患身體的相對位置做出很好的定位。這即是醫學教育上所標榜的精準定位。越是精細的手術，術前精準的定位越是重要。手術前的定位標記就是為了避免開錯邊的手術發生。尤其對於目前被廣泛使用的脊椎微創內視鏡手術而言，錯誤的定位不僅將導致手術的失敗，更可能衍生出醫療糾紛。在本報告中，我們介紹了一個罕見的腰椎定位錯誤的病例。根據病患臨床表現及神經學檢查所定的位置竟然與核磁共振攝影的影像不同。這種差異帶給了微創手術莫大的困擾。我們探查之前曾發表過的文獻，對於發生於腰椎的這種偽性定位症候的病例報告極少。在本報告中，我們將探討其可能涉及的機制並進行相關文獻之回顧。

並列關鍵字

假性局灶徵象；腰椎； Kernohan-Woltman切口現象；微創手術

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