A Critical Portion of the Case Occurs in the Clinic

Abstract

In this chapter, Dr. Li and Dr. Wang discuss the importance of a clinical perspective in neurosurgery. There are often significant disconnect and disproportion between clinical and radiological findings in the field of spine surgery, and greater emphasis should be placed upon listening to the patient than dwelling on the minutiae of radiology reports. Simple tools, such as patient-driven pain drawings and diagnostic nerve blocks, can be invaluable in focalising pain generators, while an astute ear and detailed neurological examination are necessary to exclude other, potentially more sinister, pathology, such as cervical myelopathy or neurodegenerative disease. Multiple clinic visits may be useful to assess symptom evolution, refine diagnoses, give patients time to consider their options and calibrate their expectations, and allow additional family members to participate. Whilst exhaustive lists of potential complications are important, what may be more meaningful is a candid discussion of the uncertainties present in each case, and the risks to which the patient may attach specific significance.