Kuliah Spine

7/24/2019 Kuliah Spine

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Trauma

Medula Spinalis

Dr.Dasa Sariadi Sp.BS., M.Kes

Departement of Neurosurgery

Gunung Jati Hospital


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Insidensi (USA) :

8000 10.000 kasus baru per

tahun angka cacat tinggi

20 rb 00 rb pasien parap!egi

karena trau"a "edu!a spina!is

8 # !aki$!aki


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Insidensi :A"erika: %0 kasus & 1 'uta ppu!asi !ebih

kurang 10.000 kasus& tahun

Indnesia: be!u" ada data *ang akurat

+andung (,S-S) : tahun 2002 terdapat % kasus(2# dari se!uruh trau"a)

/rea!ensi:A"erika: 21$0 kasus& 1 'uta ppu!asi

(183.000$203.000 kasus)


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Anatomy(1)

4ertebra! c!u"n

arranged in 5ie

regins : cerica! 12

thracic

!u"bar sacra!and % ccc*gea!.


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Anatomy(2)

4ertebrae

cnsists 5 :

A ertebra! bd*

A ertebra! (neura!)

arch

Seen prcesses


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Anatomy(3)

Spina! crd It is prtected b* the ertebrae and their

assciated !iga"ents and "usc!es thespina! "eninges and the 6S7.

9tends 5r" the 5ra"en "agnu" in theccipita! bne t the 2 ertebra! !ee!

;hirt*$ne pairs 5 spina! neres areattached t the spina! crd : 8 cerica! 12thracic !u"bar sacra! and 1ccc*gea!.


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Anatomy(4)

;he drsa! rts

5 spina! neres

cntain a55erent(r sensr*)

5ibers.

;he entra! rts

5 spina! nerescntain e55erent

(r "tr) 5ibers.


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/A;-?/-@SI??I (1)


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/A;-?/-@SI??I (2)


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/A;-?/-@SI??I


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/enanganan Inisia!

I


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g$,!!ing techniDue


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Patient immobilised on a rigidspinal board


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7ungsina! :

A E 6"p!ete para!*sis

+ E Sensr* n!*

6 E


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Sindr"a =!inikMotorik Sensorik

Centralcordsyndrome

Kelemahan extsuperior lebih

berat

Bermacam-macam,dibawah lesi

Myelopati retensi urin

Anterior

cordsyndrome

!araple"i

bilateral

#is sensory loss nyeri

suhu hilan", Kol postinta$ (two point dis,

position, deep press)

Posterior

cord syndr.

!aresis (%) !ain & parestisis

(burnin")

Brown-Squaredsyndrome

'psi-lat paralysisbelow lesion

Kontra-lat #is sensoryloss, ipsi-lat prop ibration hilan"


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At!ant$ccipita! dis!catin

/eran uta"a : !iga"entu"

Ceur!gi : bisa intak

;erapi : kntrersia! : perati5 atau

i"bi!isasi (% 12 bu!an)


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6$1 5racture

7raktur di arkus 6$1 E >e55ersn

7racture


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6$2 5raktur : -ang"anHs 7racture

7raktur di pars inter$articu!aris

(isth"us) di pedike! 6$2 anterir sub!ukssasi 6$2 n 6$3


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?dntid 7racture

;rau"an*a kuat


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63 6

Sub!u9atin !cked 5acets

Sub!u9atin J 3 "" angu!atin J 11K

E instabi!itas ;erapi : traksi bi!a gaga! perati5

;eardrp 5racture : harus dicari ke!ainan*ang !ain bi!a tak stabi! : perati5

-*per5!e9in Sprain

6!a* she!er 5racture : au!si prsesusspinsus stabi!


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S6IL?,A (Spina! 6rd In'ur*Githut ,adigraphic

Abnr"a!it*)

+an*ak di anak karena !iga"en

"asih e!astis dan 5acet 'int

"endatar


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;hrac!u"bar spine 5racture

Instabi!it* : three c!u"n "de!

Anterior column Anterior VB + ALL

Middle column Posterior VB + PLL

Posterior column Posterior arc + L!


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S/ICA S-?6=

-iptensi :

Sist!ik M 80 ""-g

+radikardia nadi M 0 ka!i&"enit 4asdi!atasi

/arese hingga p!egia

angguan 5ungsi neur!gi se"entara


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SI =?


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SI IC=?


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;I/ SI IC=?


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6entra! crd s*ndr"e

/art 5 3 "ain

tracts in!ed

n bth side Upper !i"bs

"re a55ected

than !Ger

!i"bs

+ S d d


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+rGn$SeDuard s*ndr"e

?ne side 5

crd a55ected

ss 5 "tr5unctin and

psitin sense

n !esin side

ss 5 painsensatin n

ppsite side

A t i d d


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Anterir crd s*ndr"e

+i!atera! !ss 5

"tr 5unctin

and painsensatin be!G

!esin

/sitin sense

presered


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/sterir crd s*ndr"e

/sitin sense

!ss be!G

!esin


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?=ASI 6F,A


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F,A>A; 6F,A


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/


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The Lateral Cervical Spine X-Ray

The LateralCervical Spine X-Ray
http://www.trauma.org/spine/images/cspineLAT.jpg


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http://www.trauma.org/spine/images/cspinealign.jpg


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http://www.trauma.org/spine/images/cspine-unifacet.jpg


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http://www.trauma.org/spine/images/cspine-bifacet.jpg


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http://www.trauma.org/spine/images/cspine-teardrop.jpg


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6; Scan

/ada !ee! tu!ang *ang abnr"a! (5t

p!s)

Sesuai !ee! de5isit neur!gi /tngan tipis 1$3 "" pada te"pat

*ang dicurigai

=adang$kadang "e"butuhkanpe"eriksaan dengan kntras


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6; Scan "ergensi

esi ink"p!it atau dengan ge'a!aneur!gi *ang "e"buruk

ee! 5raktur berbeda dengan !ee! de5isit

neur!gi ;u!ang ter!ihat nr"a! tetapi k!inis

"e"buruk. 6; Scan untuk "en*ingkirkan

'aringan !unak *ang "enekan crdsehingga per!u dek"presi segera.


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Traumatic Fracture Dislocatio L1

Post Pedicle screw i!ation " Laminectomy


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Fracture # Dislocatio C$-%

&C' Stenosis

Lateral mass platin(Pre )P


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ICFI=ASI ?/,A;I7 (1)

SI =?


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ICFI=ASI ?/,A;I7 (2)

SI IC=?


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ICFI=ASI ?/,ASI


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/,?C?SIS

PerbaikanPerbaikan PerbaikanPerbaikandgn Metyldgn Metylprednisolonprednisolon

!rankle!rankle"#B"#B

$%$% &&%&&%

!rankle!rankle'#D'#D

()%()% *(%*(%


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;,I

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