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病院

椎間板ヘルニアの病院での検査方法とセルフチェック方法

病院

椎間板ヘルニアという疑いがあるときには、病院でどのような検査が行われるのでしょうか。また、自宅で簡単にヘルニアかどうかをチェックできる方法もありますので、病院に行く前に自分でチェックしてみるのもいいですね。

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病院での検査方法

病院

椎間板ヘルニアの診断では、神経学的検査と画像検査が行われます。画像検査の結果だけで判断し、きちんと神経学的検査をしないような医師や病院は信頼性が低いと考えられます。画像上大きなヘルニアほど自然消滅しやすいというデータがありますので、無駄な手術を避けるために画像だけで判断せず、神経学的検査も行うようにしましょう。

①神経学的検査

神経学的検査とは、安静時の感覚や筋力に異常がないかを確認するために、全身を詳しく診察するというものです。筋肉の力を一つ一つ確認した上で、皮膚の感覚を注意深く調べ、筋力低下や麻痺がないかどうか診断します。膝の頭などを軽くたたくなどして、反射や手足の協調運動を診て、10~15分くらいで検査は終わります。

②画像検査

画像検査では、一般的にMRIやCTが使われますが、画像検査で椎間板ヘルニアが確認されても、病的な痛みに結びつくとは限りません。検査画像にショックを受け、急いで手術をしたがる患者さんもいるそうですが、神経学的検査の結果とも照らし合わせて、本当にそれが腰痛の原因なのか、医師と相談してどのような治療を行うかを決めていきます。

椎間板ヘルニアの診断方法

ヘルニアを治療するときに大切なのは、どんなタイプのヘルニアがどこで何番目の腰神経を圧迫しているかを正確に診断することです。MRIでヘルニアを画像上に直接映し出し、どんなタイプのヘルニアがどこにあるかを診断します。そして、神経学的検査によって、腰椎の何番目の神経機能が障害されているかを検査します。こうして得られたMRI画像所見と、神経学的検査の結果が一致したヘルニアが、症状の原因と診断されます。

多くの場合は、このような方法で椎間板ヘルニアは診断できますが、例外もあります。例えば、ヘルニアが腰椎の複数の場所に見つかり、症状の原因であるヘルニアの特定が難しい場合や、加齢によって椎間板や骨、靭帯、関節などの変性変形が進んだための変形性腰椎症や脊柱管狭窄症など、ヘルニア以外の病気が合併している場合、ヘルニアが通常発生する部分とは異なり診断自体が困難な場合などです。そのため、椎間板ヘルニアの正確な診断には、医師がMRI画像の正確な読み取りと、神経機能の評価に精通していることが必要です。

椎間板ヘルニアのセルフチェック方法

ヘルニアでは、腰痛は弱くなってきて、足の痛みが強くなってくるのが特徴です。腰痛や足の痛みが2~3週間続いているときには、ぎっくり腰ではなくヘルニアの可能性があります。自分でヘルニアかチェックできる方法がありますので、試してみてください。

①姿勢

まっすぐに立ち、背骨が曲がっているかチェックします。坐骨神経痛があれば、背骨が曲がります。

②前屈

前屈ができるかどうかやってみましょう。椎間板ヘルニアであれば、足の痛みのせいで前屈ができなくなります。

③足の筋力

つま先で立てるかどうかやってみましょう。ヘルニアの場合には、腰の神経の圧迫からふくらはぎの筋力を低下させ、足の筋力がなくなり、つま先で立つことができなくなります。

また、かかとで立つことはできますか。ヘルニアの場合には、かかとで立つことができなくなります。

④SLRT検査

仰向けに寝て、片足ずつ足を伸ばしたまま上げてみます。この時、70度以上上がれば大丈夫ですが、ヘルニアを発症していると、30度くらいで痛みがあって上げられなくなります。

手術が必要な椎間板ヘルニアとは?

ヘルニアによる症状の多くは、時間が経つにつれて改善していきますので、例外を除けば急いで手術をしなければならないというわけではありません。薬物治療や神経ブロックなどで痛みのつらい時期を乗り越えれば、多くの場合は自然に治癒していきます。

しかし、一向に症状の改善が進まない場合は、よくならない理由が必ずありますので、専門医の診察が必要です。手術治療の時期については、ヘルニア発症後3~6カ月経過しても生活に支障をきたす痛みやしびれ、座位や歩行障害が続いている場合には手術治療が必要になります。ただし、3カ月以内でも下肢の筋力低下が進む場合や、排尿・排便機能障害が現れている場合には早急な手術治療が必要です。

まとめ:早期発見で椎間板ヘルニアを早く治そう

病院ではMRIなどの画像検査や、安静時の感覚や筋力に異常がないかを確認するために、全身を詳しく診察する神経学的検査を行い、総合的に診断されます。的確に痛みの部分を見つけて、早期発見して椎間板ヘルニアを早く治すようにしましょう。

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