[Essentials and Pitfalls of Neurological Examination:From Symptoms to Lesion Localization]

In neurosurgical practice, neurological examinations must be tailored to the disease type and stage, with emphasis on findings most relevant to clinical decision-making. In spinal surgery, neurological assessment plays a crucial role in identifying the precise level and localization of lesions. Accurate evaluation requires systematic assessment of sensory disturbances based on dermatomal distribution, strength testing of key muscles with attention to myotomal innervation, evaluation of deep tendon reflexes, and assessment of bladder and bowel dysfunctions. A structured and focused examination enables clinicians to translate symptoms into accurate lesion localization. This review summarizes the essential components of neurological examinations required to identify spinal lesions and highlights the common pitfalls that may lead to diagnostic errors. Practical strategies to improve diagnostic accuracy are discussed, with particular emphasis on supporting early-career neurosurgeons in developing reliable clinical reasoning skills.