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MIELOPATI SERVIKAL

WINDA SETYOWULAN 030.09.269 RSUD KOTA BEKASI

Pembimbing: Dr. Rudy Yunanto, Sp.BS

PENDAHULUAN
Cedera medula spinalis penyebab utama disabilitas neurologis akibat trauma 10.000 kasus baru per tahun di Amerika (The National Spinal Cord Injury Data Research Center) Kecelakaan bermotor = penyebab utama! Mielopati servikal sering pada usia lanjut akibat stenosis atau spondilosis
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ANATOMI MEDULA SPINALIS


Terletak di dalam canalis vertebralis 31 segmen:
8 servikal 12 thorakal 5 lumbal 5 sakral 1 koksigeal
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ANATOMI VERTEBRA CERVICAL

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FISIOLOGI MEDULA SPINALIS

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PEMBAHASAN
MIELOPATI SERVIKAL

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DEFINISI

Gangguan fungsional dan atau anatomi dari medula spinalis


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PATOGENESIS

Trauma vertebra

Infeksi

Tumor

Kongenital

Degenerasi

Herniasi

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GEJALA KLINIS
Penyebab mielopati sulit untuk dideteksi karena perkembangannya yang lambat dan bertahap Gejala dari kompresi yang terjadi*:
Gejala sensorik Nyeri, parestesi Gejala motorik Kelumpuhan Gejala otonom Gangguan respirasi, sirkulasi, miksi, dan defekasi

*(tergantung segmen yang mengalami kompresi)


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GEJALA KLINIS
Gejala yg biasanya dirasakan pasien:
riwayat sakit leher atau punggung yang panjang perubahan dalam koordinasi gerak tungkai terasa berat kesulitan melakukan aktivitas dan tugas yang sebelumnya mudah nyeri atau sensasi tersengat listrik paralisis baal atau kesemutan anggota gerak Gejala bersifat akut, subakut, kronik progresif

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GEJALA KLINIS
Regio C3 C6 Keterampilan menurun (kesulitan menulis), perubahan sensasi serta kelemahan lengan Regio C6 C8 Sindroma spastisitas dan hilangnya proprioseptik tungkai
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PEMERIKSAAN FISIK
Kelemahan ekstremitas Spastic gait Status neurologis
Hoffman (+)

Hipertonus

Tanda UMN

Hiperrefleks

Babinski (+)

Klonus ankle (+)

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KLASIFIKASI
Berdasarkan ada/tidaknya fungsi yang dipertahankan di bawah lesi
Karakteristik Motorik Protopatik (nyeri, suhu) Propioseptik (joint Lesi Komplit Hilang di bawah lesi Hilang di bawah lesi Hilang di bawah lesi Negatif Sering fraktur, luksasi, atau listesis Lesi Inkomplit Sering (+) Sering (+) Sering (+) Positif Sering normal

position, vibrasi)
Sacral sparing Ro vertebra

MRI
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Hemoragi (54%), kompresi


(25%), kontusi (11%)
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Edema (62%),
kontusi (26%), normal (15%)
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KLASIFIKASI
Score Definition Unable to walk, wheelchair Walking of flat ground only with cane or aid Climbing stairs only with aid Gait clumsy, but no aid necessary Normal walking and climbing stairs Retention, no control over bladder and/or bowel function Inadequate micturition and urinary frequency Gait Function

European Myelopathy Score


17-18 13-16 9-12 5-8 : normal : grade 1 : grade 2 : grade 3

1 2 3 4 5 1 2

Bladder and Bowel Function

3
1 2 3 4 1 2 3 1

Normal bladder and bowel function


Handwriting and eating with knife and fork impossible Handwriting and eating with knife and fork impaired Handwriting, tying shoelaces or a tie clumsy Normal handwriting Getting dressed only with aid Getting dressed clumsily and slowly Getting dressed normally Invalidity due to pain Endurable paraesthesia and pain No paraesthesia and pain

Hand Function

Proprioception and Coordination

Paraesthesia/Pain 2 3

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KLASIFIKASI
Nuricks Score
Grade Grade I Grade II Level of Neurological Involvement No difficulty in walking Mild gait involvement not interfering with employment

Grade III
Grade IV Grade V

Gait abnormality preventing employment


Able to walk only with assistance Chairbound or bedridden

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PEMERIKSAAN PENUNJANG

Lab darah

Rontgen

CT scan / MRI

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KRITERIA DIAGNOSIS
Diagnostic Criteria for Cervical Spondylotic Myelopathy Characteristic symptoms (leg stiffness, hand weakness)
Characteristic signs (hyperreflexia, atrophy of hands)

MRI or CT (showing spinal stenosis and cord compression as a result of osteophyte overgrowth, disc herniation, ligamentum hypertrophy)

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PENATALAKSANAAN
Tujuan: meningkatkan dan mempertahankan fungsi sensoris dan motoris Terapi konservatif:
Imobilisasi soft collar neck Metilprednisolon high dose
30 mg/kgBB IV dalam 8 jam pertama dilanjutkan 5.4 mg/kgBB/jam selama 23 jam berikutnya

Simptomatik analgetik Rehabilitasi medik fisioterapi, bladder training Terapi okupasi alat bantu

Terapi operatif
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PROGNOSIS
American Spinal Injury Association
Group A Group B Group C Complete Sensory Incomplete Motor Incomplete Motor and sensory loss below the lesion Some sensory preservation below the zone of injury Motor and sensory sparing, but the patient is nonfunctional

Group D

Motor Incomplete

Motor and sensory sparing and the patient is functional (stands and walks)
Reflexes may be abnormal

Group E

Complete functional recovery

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PROGNOSIS
Sebuah penelitian prospektif selama 27 tahun menunjukkan bahwa rata-rata harapan hidup pasien cedera medula spinalis lebih rendah disbanding populasi normal. Penurunan rata-rata lama harapan hidup sesuai dengan beratnya cedera. Penyebab kematian utama adalah komplikasi disabilitas neurologi yaitu: pneumonia, emboli paru, septikemia, dan gagal ginjal.

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DAFTAR PUSTAKA
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2.
3. 4. 5.

6. 7.
8. 9. 10.

York JE. Approach to the patient with acute nervous system trauma. Best Practice of Medicine. September 2000. Young W. Spinal cord injury levels and classification. Care Cure Community. Keek Centre for Collaborative Neuroscience. 2002. Hoppenfield S. Orthopaedic neurology: a diagnosis guide to neurologic levels. JB Lippincott Williams. 1977. FSIP. Spinal cord injury facts: statistics. Foundation for Spinal Cord Injury Prevention, Care and Cure. 2001. Pinzon R. Mielopati servikal trauma: telaah pustaka terkini. Cermin Dunia Kedokteran 154; 2007: 39-42. Hansen JT. Netters clinical anatomy. 2nd Ed. Philadelphia; Saunders Elsevier: 2010. p.60-3. Sherwood L. Human physiology from cells to systems. 7th Ed. California; Brooks/Cole: 2010. p.172-7. Klezl Z, Coughlin TA. Cervical myelopathy. 2013. Available at: http://www.boneandjoint.org.uk/content/focus/cervical-myelopathy. Accessed on February 19, 2014. Department of Neurosurgery Columbia University. Cervical myelopathy. 2014. Available at: http://www.columbianeurosurgery.org/conditions/cervical-myelopathy/. Accessed on February 20, 2014. Young W. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000;62(5):1064-70.

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