S(K), DFM
Departemen Neurologi
Fakultas Kedokteran, Universitas Hasanuddin
Makassar 2022
PENYEBAB NYERI
PUNGGUNG
BAWAH??
1 OTOT PUNGGUNG
(paling banyak terjadi 60 – 70%)
CIRI KHASNYA:
1.Nyeri TERLOKALISIR
di satu tempat
2.Rasa seperti TUMPUL
(kemeng, linu, cekot2)
3.Membaik dengan
PEMIJATAN
4.Mendadak (AKUT)
2 TULANG BELAKANG + PERSENDIAN
CIRI KHASNYA:
1.Nyeri TERLOKALISIR
di satu tempat
2.Rasa seperti TUMPUL
(kemeng, linu, cekot2)
3.TIDAK membaik
dengan PEMIJATAN
4. LAMA (KRONIS)
3 SARAF SPINAL
CIRI KHASNYA:
1.Nyeri MENJALAR
sampai ke kaki
2.Rasa TAJAM, seperti
tersetrum, terbakar,
disilet, kesemutan dan
mati rasa
3.TIDAK membaik
dengan PEMIJATAN
4. bisa AKUT / KRONIS
4 ORGAN
CIRI
KHASNYA:
Tergantung
organ yang
terkena
BATU GINJAL
CIRI KHASNYA:
1. MENDADAK, HILANG
TIMBUL
2.Nyeri seperti DIREMAS-
REMAS (KOLIK)
3. Sangat nyeri bila
DIPUKUL pada daerah
CVA
4.Urin (air seni) keruh atau
kemerahan
1. SPONDILOSIS ANKYLOSING
(pengapuran sendi)
2. SPONDILOLISTESIS
(sendi bergeser)
3. OSTEOPOROSIS
(pengeroposan tulang)
4. Hernia Nucleousus
Pulposus (HNP)
4. Hernia Nucleousus
Pulposus (HNP)
5. Spinal stenosis
▹ Lumbar spondylosis refers to
degenerative conditions of the lumbar
spine that narrow the spinal canal,
lateral recesses, and neural foramina.
Facet joint and ligamentous
hypertrophy, intervertebral disc
protrusion, and spondylolisthesis may
all contribute to the stenosis, and
symptoms result from neural
compression of the cauda equina,
exiting nerve roots, or both.
3
6. Compression fracture
▹ Most osteoporotic spinal compression fractures
represent an isolated failure of the anterior
spinal column due to a combination of flexion
and axial compression loading.
4
6. Compression fracture
▹ plain x-rays:
▹ MRI?
▹ Useful in distinguishing between osteoporotic
compression fractures and those caused by
underlying tumour or infection.
4
1 Personal Data
2 SOCRATES
3 Neurological?
Hx taking
4 Red Flags!
5 PMH
6 Past Surgical Hx
7 Medications
8 Family, Social & Systemic Review
1 Personal Data
Age? Residence?
Occupation?
Hx taking
2 SOCRATES
Site? Associated?
Onset? Timing?
Character? Exacerbating?
Radiation? Severity?
3 Neurological?
Hx taking
4 Red Flags!
5 PMH
Trauma? Cancer? Psychiatric?
Past Surgical Hx
Hx taking
6
7 Medications
Steroid?
• Other referrals
1. Recalcitrant spinal canal stenosis
2. Neoplasia or infection
3. Undiagnosed back pain
4. Paget disease
5. Continuing pain of 3 months’ duration without a clearly definable cause
Prevention and education
• Losing weight: too much upper body
weight can strain the lower back .
• Posture: How you sit, stand and lie down can
have an important effect on your back. The
following tips should help you maintain a good
posture.