Ahmad Fauzi
Divisi Orthopaedi & Traumatologi
Ilmu Bedah FK UNILA
TRAUMA
6 point scale
0 = total paralysis
1 = palpable or visible contraction
2 = active movement, full ROM with gravity eliminated
3 = active movement, full ROM against gravity
4 = active movement, full ROM against moderate resistance
5 = (normal) active movement, full ROM against full resistance
Key muscles:
C5 - Elbow flexors (biceps, brachialis)
C6 - Wrist extensors (ECRL, ECRB)
C7 - Elbow extensors (triceps)
C8 - Finger flexors to the middle finger (FDP)
T1 - Small finger abductors (AbDM)
L2 - Hip flexors (iliopsoas)
L3 - Knee extensors (quadriceps)
L4 - Ankle dorsiflexors (tibialis anterior)
L5 - Long toe extensors (EHL)
S1 - Ankle plantarflexors (gastrocnemius, soleus)
Other muscles also evaluated but their grades are not used in determining motor score or motor
level [diaphragm (fluoro), deltoids, abdominals (Beevor's sign), medial hamstrings, hip
adductors - graded as absent, weak or normal; anal sphincter - Yes/No].
For myotomes not testable, the motor level is presumed to be the same as the sensory level.
Motor level (L or R), defined by the lowest key muscle that has a grade of at least 3, provided
the key muscles above are normal.
Complete
Incomplete
Incomplete
Incomplete
Normal
POSTERIOR
MIDDLE
ANTERIOR
3 Columns
(Denis
Classification)
Compression
Fracture
Burst Fracture
Flexion-distraction
Injury (Chance)
Fracture Dislocation
Stability
Neural Injury
Compression
Stable
Nil
Burst fracture
Unstable
Nil to severe *
Flexion-distraction
Unstable
Nil to severe *
Fracture dislocation
Unstable
Severe
Aims of Treatment
CONSERVATIVE TREATMENT
Used only for minor and stable fractures
Bed rest
X Postural reduction (lumbar spine)
Ambulatory treatment
Spinal jacket (TLSO)
Free ambulation to pain tolerance
SURGICAL TREATMENT
SPINAL STABILISATION
BONY RECONSTRUCTION
SPINAL INSTRUMENTATION
SPINAL DECOMPRESSION
Direct : Removal of bony fragments
Indirect : Re-alignment of the spine
SPINAL STABILISATION
Earlier mobilisation for rehab
Promote rapid soft tissue healing
Burst Fracture
Burst Fracture
Fracture Dislocation
Fracture Dislocation
INFECTION
Spondilitis Tuberculosis
Epidemiology
One of the most common problem in the developing
countries
Indonesia is in the 3rd place for the most TB contributing
country after India & China
Almost of all the patient is in the range of productive age
(15 54 years old)
Vertebrae is the 2nd common place for infected organ by
Mycobacterium Tuberculosis ( 50% )
15% of all extra pulmonary TB cases
Male > female & Children > adults
The most common site ; thoraco-lumbar , thoracal,
lumbar, and cervical
Pathogenesis
Secondary infection focus from the other part of organ
Infection pathways
Clinical appearance
Laboratory findings
Leukocyte >>>
SER is prolonged
CRP (C-reactive protein )
ELISA (false negative >>)
PCR (polymerase chain reaction)
Tuberculin test (Mantoux)
Immunology test
Intradermal tuberculin
test ( Mantoux )
67,5 87,5 % positive
Biopsy
Identifikasi basil
tuberkel diagnosis
yang definitif
Pewarnaan dengan
basil tahan asam,
fluorokrome dan
Ziehl-Nielsen atau
kultur
Plain radiographs
Affected vertebrae (segment
& number)
Bone destruction rate
Khypose angle
Anterior part destruction
Paravertebrae abscess
(fusiform shadow)
Narrowing of adjacent discs
Osteolytic lesion
MRI :
Central necrosis (abscess)
Inhomogen appearance
Histo - pathology
Gambaran granuloma
Treatment
The aim : eradicate the infection, stabilize the
Surgical therapy
The indications :
Significant neurological deficit
Cervical segment abscess
Posterior lesion with abscess or sinus
Vertebrae instability / progressive khypose
Failed of chemotherapy treatment in 3 6
months
Recurrence infection
Degenerative
Definisi
Nyeri pada punggung bawah
Etiologi
Spinal
Degeneratif
Infeksi
Trauma
Kelainan bawaan
Non spinal
Viserogenik
Vaskulogenik
Neurogenik
Psikogenik
Biomekanik
Anamnesis
Onset nyeri
Lokasi
Kualitas
Kuantitas
Yang memperberat
Yang memperingan
Pemeriksaan fisik
Pemeriksaan refleks
Lasegue tes
SLR tes
Pemeriksaan penunjang
Radiologis
Cek darah lengkap
EMG
Urinalisa
Viscerogenik
Karakteristik :
pelvis
yang
tidak
Vaskulogenik
Abnormalitas dari aorta descendens dan arteri
iliaka, misalnya sumbatan vaskuler atau
aneurisma
Degenerasi Discus
batuk, menguap,
cekukan, atau posisi
badan membungkuk ke
depan, berdiri lama
Terapi
1. Konservatif
Moderate bed rest
Spinal manipulation
Physical therapy
Medication
NSAIDs
Muscle relaxants
Rarely narcotics
2. Operatif
Indikasi Operatif
TERIMA KASIH