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MAKALAH

INFEKSI VERTEBRA
DISUSUN OLEH :

EDWARD 090100079
FELIX LEO 090100121
HEMA THIYAGU 090100408
THEVAGIH EHAMBARAM 090100421
CHRISTY DYMPHNA 090100425
PEMBIMBING:
dr. PRANAJAYA DHARMA KADAR, SpOT(K)

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Anatomi
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Definisi
Infeksi Kolom vertebral (tulang), diskus
intervertebralis, kantung dural (meliputi sekitar
sumsum tulang belakang) atau ruang di sekitar
sumsum tulang belakang. Infeksi dapat disebabkan
oleh bakteri atau organisme jamur.
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Etiologi
Septik arthritis, sinusitis, subakut endokarditis
bakteri, dan pernapasan, oral, atau infeksi
gastrointestinal.
Sekitar 30-70% pasien dengan osteomielitis vertebral
tidak memiliki infeksi jelas sebelumnya.
Selain itu etiologi yang menyangkut juga adalah
mengalami bedah waktu lama, instrumentasi dan
operasi kembali.Kebanyakan infeksi pasca operasi
terjadi antara tiga hari dan tiga bulan setelah saat
operasi.

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Epidemiologi
Osteomielitis vertebral dianggap jarang, dengan kejadian 1
kasus per 100,000-250,000 penduduk per tahun.
Osteomielitis memiliki kecenderungan untuk laki-laki.
Di negara-negara kurang berkembang, osteomielitis
menular lebih umum.
Abses Epidural dapat terjadi pada semua usia, tetapi yang
paling umum pada orang usia 50 dan lebih tua.
Beberapa studi menunjukkan bahwa kejadian infeksi
tulang belakang kini meningkat. Spike ini mungkin
berhubungan dengan peningkatan penggunaan perangkat
pembuluh darah dan bentuk lain dari instrumentasi dan
peningkatan penyalahgunaan obat intravena.
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DIAGNOSIS
Clinically manifested as:
Back pain (local, insidious onset, gradually progressing
and increases in intensity, aggravated by movement)
Mild tenderness over the spinous process of the involved
vertebra, minimal paravertebral muscles spasm,
decreased range of motion
Fever (only about half of patients)
Neurologic deficits
Sensoric examination sensory level, posterior column
function, normal and abnormal reflexes, examination of
rectal tone and perianal sensation
Motoric examination muscle strength and weakness
graded ranging from strenght of 5/5, considered normal,
to a strength of 0/5, or paralysis
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DIAGNOSIS
The process of diagnosis a spinal infection begins with
a plain radiograph (usually nrmal in the first 2-4
weeks)
Abnormalities found:
Narrow disk space and destruction of the endplates
around the disk
Rarefaction, loss of bony trabeculation close to the
cartilaginous plate, and an irregular narrowing of the
vertebral disk space
Vertebral body collapse
Rapid bone regeneration may be evident
A paravertebral soft-tissue mass may be present
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DIAGNOSIS
CT scans depicts osteomyelitis earlier than plain films
The findings include:
Hypodensity at the infected disks
Lytic fragmentation of the involved bone
Gas within an involved vertebra
Decreased density of adjacent vertebra and nearby soft
tissues
Epidural and paraspinal extension of infection may also
be seen
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DIAGNOSIS
MRI of the spine provides information that is not
available with CT scans, paravertebral infection,
collections under the posterior longitudinal ligament,
and epidural abcesses
Bone scans with technetium Tc 99m are very sensitive
early indicators of pyogenic vertebral osteomyelitis
(become positive long before plain film changes are
evident), but is not useful for specifically
differentiating infection from metastasis or
osteoarthritis
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Treatment
1. Medical therapy
- Antibiotic based on isolated organism
- Parenteral antibiotic 6-8 weeks is effective in most
cases
2. Surgical therapy
- Indications :
Significant ossues involvement
Neurological deficits
Septic course from an abscess not responding to antibiotics
Failure of needle biopsi to obtain necessary cultures
Failure of iv antibiotic to eradicate the infection

- Goal : preservation of neural function & achievement
of stable fusion without severe kyphosis
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Follow Up
Neurologic monitoring
Parenteral antibiotics are given until the infection
resolves
Rehabilitation for any residual neurologic deficit
Falling ESR & decrease in serum CRP is consistent
with successful treatment
Serial radiographic studies to detect bony collapse
or deformity
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Prognosis
Most patients can be cured by a treatment protocol that
includes antibiotics alone or in combination with surgery
Several studies indicate that paresis may improve or resolve
with aggressive antibiotics and surgical therapy
15% patients experience permanent neurological deficits
Recrudescence of infection occurs in 2-8% patients
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Komplikasi
Defisit neurologis berkembang pada 13-40% pasien,
terutama mereka dengan diabetes atau penyakit
sistemik lainnya.
Terapi antibiotik jangka panjang dapat menyebabkan
ototoksisitas atau toksisitas ginjal.
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THANK
YOU
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