Spinal Cord and Low

Back Pain

Muhammad Yusuf

1 MYS
• MEDULA SPINALIS >>
CANALIS
INTERVERTEBRALIS
• 40-45 CM
• FOR. MAGNUSM --- L2-3
• SARAF SPINALIS
(KELUAR-MASUK) >>
FOR.
INTERVERTEBRALIS
• 8 CERVICAL
• 12 THORACAL
• 5 LUMBAL
• 5 SACRAL
• 1 COCCYGEAL
MYS 2
 BENTUK LUAR

• Ø ANTEROPOSTERIOR < Ø
LATERAL
• Ø MELEBAR DI SERVIKAL –
THORAKAL BAWAH
(INTUMESCENSIA
SERVIKAL/THORAKAL)
• UJUNG BAWAH >> CONUS
MEDULARIS
• SARAF SPINAL L1-2
• EKOR KUDA ---CAUDA EQUINA
• SELAPUT PEMBUNGKUS:
1. PIAMATER
2. ARAKHNOID
3. DURAMATER

MYS 3
BENTUK DALAM
• Potongan melintang >>>
• substansia Grisea (kupu-kupu)
• substansia Alba (bag. Luar)
• cornu posterior
• postero – lateral MS
• cornu anterior
• afferent >>>> cornu posterior
efferent >>>> cornu anterior
hukum Bell - Magendie

MYS 4
 FUNIKUKUS DORSALIS

SEPTUM MEDIANA DORSALIS

FUNIKULUS LATERALIS
KANALIS SENTRALIS
KOLUMNA GRISEA
DORSALIS

KOMISURA
GRISEA
ANTERIOR

FUNIKULUS VENTRALIS
KOLUMNA GRISEA
INTERMEDIOLATERAL
FISURA MEDIANA VENTRALIS

KOMISURA ALBA ANTERIOR

MYS 5
EFFERENT >>> SARAF KE DUA (SUB.GRISEA)
EFFERENT >>> SUBSTANSIA GRISEA
^
BADAN SEL
^
LOKASI BERBEDA
(9 LAMINA ------REXED)
• LAMINA I ----NUCLEUS POSTERIOR MARGINALIS
• LAMINA II ---SUBTANSIA GELATINOSA (ROLANDO)
• LAMINA III & IV ----- NUCLEUS PROPEUS
^^^^^
KETIGA NUCLEUS
SISTEM SOMATIS & SENSORIS UMUM
• LAMINA VIII --- NUCLEUS CLARKE --- CEREBELLAR
• LAMINA VII & IX --- NUCLEUS MOTORIS
• LAMINA VII ---- NECLEUS OTONOM

MYS 6
 DESCENDENS

Tr. Corticospinalis lateralis Tr. Corticospinalis anterior

YG. LAIN Tr. Tectospinalis

Tr. Rubrospinalis

JARAS SENSORIS • deep sensation:

- raba dalam
- fibrasi
JARAS MOTORIS -diskriminasi 2 titik
• superfisial sensoris
- nyeri
Tr. Corticospinalis - suhu
- raba halus
Tr. Rubrospinalis
Tr. Olivospinalis MYS 7
 Tr. Corticospinalis Lateralis

Anterior Lateral

15% Ipsilateral 85% Kontra lateral

Sel Motoris Cornu Anterior MS + saraf Spinal + Motor End Plate

Final Common pathway

Tr. Rubrospinalis :
- >> aktivitas otot flexor
- << aktivitas extensor (inhibisi)

Tr. Olivospinalis :
- mengatur tonus dan gerakan otot
MYS 8
BAG. TENGAH MS Canalis Centralis

(Sisa dari neural tube)

Berisi LCS

MYS 9
SEGMEN KORPUS PROSESUS
MEDULA SPINALIS VERTEBRA SPINOSUS

C8 Lower C6 dan Upper C7 C6

T6 Lower T3 dan Upper T4 T3
T12 T9 T8
L5 T11 T8
S T12 dan L1 T12 dan L1

MYS 10
1. Arteri Spinalis Anterior
2. Arteri Spinalis Lateralis
3. Arteri Spinalis Medialis Anterior
4. Arteri Spinalis Posterior
5. Arteri Sulcalis Anterior

MYS 11
In 19th Century --- almost every diseasa of the Spinal Cord
Labeled  “MYELITIS”

Today The Locus of limited number of:………

* Inf. And Non Infective Inflam..process
* Some causing selective destruct.. Of neurons
* Affecting primarily white matter (tracts)
* Involving the meninges and White matter

MYS 12
 MYELITIS

Gray matter…… Poliomyelitis

White matter …. Leukomyelitis
The whole crossectional are…Tranversemyelitis
Lesions are multiple and wide spread Over a long vertical extent…..
Diffuse Or Disseminated
Combined meninges and spinal cord…Meningomyelitis
Combined meninges and root--- meningpradiculitis.
Inflammatory disease limited to the spinal dura…. Pachymeningitis
Infected material collects in the epidural or subdural space… Epidural
spinal Or subdural spinal abcess or Granulomatous

MYS 13
I. Viral myelitis (Entero virus, Herpes zoster, AIDS, Rabies,
Japanese B virus, HTLV-1)
II. Myelitis secondary to bacterial, fungal, parasitic, and primary
granulomatous disease of the meninges and spinal cord.
( Mycoplasma pneumoniae, Lyme disease, pyogenic myelitis
Tuberculous myelitis, Parasitic and fungal infection, Sypilitic
Myelitis, Sarcoid myelitis)
III. Myelitis (myelopathy) of non infectious inflammatory Type
( Post infectious and postvaccinal Myelitis, Acute and chronic
relapsing or progressive multiple sclerosis, Subacute necrotizing
myelitis, Myelopathy with lupus or other forms of angitis,
Paraneoplastic myelopathy and poliomyelitis)

MYS 14
MYELITIS DUE TO VIRUSES

Coxsacki and Polio AFFINITY….

Herpeszoster •Enterovirus….anterior horn…
Enteroviruses and nuclei of the Brainstem
Cytomegalo virus •Herpeszoster….. Dorsal root ganglia
Epstein-Bar virus …etc

CLINICAL MANIFESTATION

•Acute paraplegic or Quadriplegic

•Urinary retention
•Sensory disturbances

MYS 15
 TUBERCULOUS MYELITIS

* Pott’s disease (tuberculous osteitis of the spine with khyposis…

pus or caseous granulation tissue may extrude from an infected
vertebra and gives rise to an epidural compression of the cord…
Pott’s paraplegia
* Tuberculous meningitis  Pia arteritis and Spinal cord Infarction

The paraplegic may appear before ---the tuberculous meningitis

Is diagnosed

MYS 16
•Children and adults may be affected
•Has a wide variety of sources:
* an injury to the back
* furunculosis
* a bacteriemia
* Osteomyelitis with extension to the epidural space
* Spinal surgery
* Lumbar puncture
* Epidural injection
•Etiologic agent:
* Stapylococcus aureus (the most frequent)
* Gram negative bacilli
* Anaerobic organisms
MYS 17
Fever and pains in the back
Radicular pain (several days)
Headache and nuchal rigidity (sometimes)
Paraparesis, paraplegia or quadriplegia
Sensory loss
Sphincteric paralysis with urinary and fecal retention

MYS 18
 examination

Small number of white cells ( < 100/ mm3

Polymorphonuclear leukocytes and Lymphocytes
Protein is relatively high (100-400 mg/100 ml or more)
Glucose is normal

M R I spine
CT spine
: Antibiotic and Surgical
MYS (laminectomy and drainage)
19
 VASCULAR DISEASES of the SPINAL CORD

The spinal cord arteries tend not to be susceptible to atherosclerosis

And emboli
Infarction
VASCULAR DISORDER Bleeding
Arteriovenous malformatios

Relation to operation on the aorta (aorta must be clamped for

Some periode of time)

MYS 20
 MYELOMALACIA

Infarction of the spinal cord

The resulting clinical abnormalities are generaly refered to as the

“Anterior Spinal Artery Syndrome”

21 MYS
 ETIOLOGI

1. Atherosclerosis And Thrombotic Occlusion (un common)

2. Cocaine user  Ischemic myelopathy
3. Clamping aorta >> 30 minutes (cardiac and aortic surgery)
4. Polyarteritis nodosa

Clinical manifestation:
•Pain in the neck and back EXAM
•Motor paralysis
•Radicular pain
•Loss of pain and thermal sensation
•Paralysis of spincteric function MRI

Symptomatic
Treatment
Care of bladder, bowel and skin
After 10-14 days  active rehabilitation
MYS 22
High dose Corticosteroid or Heparization – is not known
 CORD HERNIATION due to DURAL TEAR
Etiologi …… Trauma to the Spinal Cord or Skull  arachnoidal and dural tear
Usually in the mid or high thoraxic region  segment of spinal cord protrude into
The epidural space.

CLINICAL MANIFESTATION
•Pain less
•Subacute and incomplete spinal cord syndrome
•A symmetrical spastic paraparesis
•Variable sensory loss

EXAM
TREATMENT SURGICAL
M R I
MYS 23
SPINAL CORD TUMOR

•Less frequent than brain’s tumor

•Majority of intra spinal tumor are benign

Neoplasm and other Space Occupying Lesions can be divided into:

1. Those that arise within the substance of the spinal cord either as a
primary or metastasis, and invade and destroy tracts and central
gray structures (Intra medullary)
2. Those arising out side the spinal cord (Extra medullary), either in the
vertebral bodies and epidural tissue (Extradural) or in leptomeninges
or roots (Intra dural).

Frequency:
5% Intramedullary
40% Intradural-Extramedullary
55% Extradural MYS 24
Primary extramedularry:
* Neurofibromas and meningiomas
* Sarcomas
* Vascular tumors
* Chordomas
* Epidermoid

Primary Intramedulaary tumor

* Ependymomas
*Astrocytoma
* Oligodendroglioma
* Non Gliomatous tumor:
- Lipomas
- Epidermoid
- Teratomas
- Hemangiomas
- Metastatic carcinomas
MYS 25
 SPINAL CORD TUMORS

SCT primary
secondary (metastatic)

ADULTS CHILDREN
1. EXTRADURAL 78% 18%
metastase metastase
myeloma lymphoma
neurofibroma, etc
2. INTRADURAL 18% 64%
meningioma dermoid/epidermoid
schwannoma,etc etc
3. INTRAMEDULLARY 4% 18%
astrocytoma astrocytoma

MYS 26
 SIGNS AND SYMPTOMS

Intramed Intradural Extradural

Signs Pain + Pain, metastatic +++ Pain +++
Sensory loss Pain, primary + Radicular or
Early sphincter dysf. Radicular or local local
Sensory loss-radic.
Symp. Rectal tone Radic or segmental
Post void residual weakness & sensory
Sacral sparing loss
Spasticity UMN signs
UMN signs
Type>>Ependymoma Meningioma Metastatic

MYS 27
 PRIMARY SPINAL CORD TUMORS
• uncommon, mostly astrocytomas (54%) or ependymomas (40%).
• Incidence : M 0,14/100.000 F 0,11/100.000
• Locations :
Astrocytoma : cervical and upper thoracic
Ependymoma : lower thoracic and lumbar

• Treatments :
Ependymoma Astrocytoma
Surgery : complete resection rarely possible
(infiltrative)

Radioth : rec and progressive ep. post op radioth

Chemoth : rec. ep. Parallel tx
for intracr.
tumors
MYS 28
METASTATIC TUMORS

Primary sites : breast, lung, prostate, or kidney

Metastatic sites : >> thoracic vertebrae
Any site, maybe multiple
Clinical features : bone pain and tenderness usually
preceding limb and autonomic
dysfunction

Management :
1. Pain control : narcotic analgesic + high dose
corticosteroid
2. Specific therapy :
Radiotherapy
Surgery
Hormonal agents : hormone-sensitive tumors
Chemoth
MYS 29
DIAGNOSTIC INVESTIGATIONS :

 Plain x-ray : AP, lateral, oblique

 MRI : investigation of choice
 Myelography
 CT scan/CT myelography
 CSF analysis : protein often increase,
cytology

MYS 30
 HEMANGIOMAS  spontanous hematomyelia
INTRAMEDULLARY TUMOR:
•compress and distort fasciculi In the spinal cord white matter
•Compresed – CSF below the lesion become isolated or loculated
from the remainder of the circulating fluid above the lesion

FROIN SYNDROME
Xanthocromia and Clotting of CSF

Symtomatology:
1. A sensorimotor spinal tract syndrome
2. A painful radicular-spinal cord syndrome
3. Rarely, an intramedullary syringomyelic syndrome
MYS 31
Pain and stifness of the back:
clinical picture extramedullary tumor
Back pain:
worse when the patient lies down on may become worse
after several houer in recumbent position and be improved
by sitting
In children:
* severe back pain associated with spasm of paravertebral
muscle is often prominent initially
* scoliosis and spastic weakness of the legs come later

EXAMINATION Treatment:
1. Surgical
1. Examination of the CSF 2. Corticosteroid
2. CT- Myelography 3. Radiation
3. M R I
MYS 32
 SYRINGOMYELIC SYNDROME OF THE SEGMENTAL
SENSORY DISSOCIATION WITH
BRACHIAL AMYOTROPHY

Defined:
a chronic progressive degenerative or developmental
disorder of the spinal cord, characterized clinically by
weakness and wasting of the hands and arms (brachial
amyotrophy) and segmental sensory loss of dissociated
type (loss of thermal and painfull sensation with sparing
of tactile, joint position, and vibrating sense).

PATHOLOGICALLY
•Cavitation of the central parts of the spinal cord
•Associated developmental abnormalities with vertebral
MYS 33
column, base skull, cerebellum and brainstem.
90% syringomyelia have type I chiarimalformation
50% type I chiarimalformation associated with syringomyelia

Clinical features:
* begin 20-40 years
* male=female
* segmental weakness
* atrophy of the hands and arms
* loss of tendon refexes
* segmental anasthesia of a dissociated type:
 loss of pain and thermal sense
 preservaton of the sense of touch
 over the neck, shoulders and arms
* weakness and ataxia of the legs
* Kyposcoliosis

MYS 34
 (Modified from Barnett et al)

Type I:
Syringomyelia with obstruction of the foramen magnum and
Dilation of the central canal
A. With type I Chiari malformation
B. With other obstructive lesions of the foramen magnum

Type II:
Syringomyelia without obstruction of the foramen magnum
(idiopathic type)

MYS 35
Type III
Syringomyelia with other disease of the spinalcord (acquired types)
A. Spinal cord tumors (usually intramedullary)
B. Traumatic myelopathy
C. Spinal arachnoiditis and pachymeningitis
D. Secondary myelomalacia from cord compression (tumor,
spondylosis) or infarction (AVM, etc)

Type IV
Pure hydromyelia (developmental dilatation of the central canal),
usually With hydrocephalus

MYS 36
 examimation

•M R I
•MYELOGRAPHY
•CT SCAN

TREATMENT
TREATMENT
TREATMENT

Surgical
MYS 37
LOW BACK
PAIN

MYS 38
 DEFINISI:
Nyeri Punggung Bawah (NPB) adalah Nyeri yang
dirasakan di daerah punggung bawah, dapat
merupakan nyeri lokal maupun
nyeri radikular atau keduanya
(Pokdi Nyeri Perdossi)

EPIDEMIOLOGI

NPB:
* Merupakan salah satu dari 10 alasan pasien
mengunjungi Dokter
* Prevalensi: 7.5-37% dari Populasi (USA)
* Prevalensi teringgi pada rentang usia 45-60 tahun
* 80% orang dewasa pernah mengalami NPB akut
* Th 1991 di US diperkirakan $ 25 billion / tahun

MYS 39
 KLASIFIKASI NPB BERDASARKAN LAMANYA

NPB diklasifikasikan ke dalam:

1. Akut NPB (< 6 minggu)
2. Subakut NPB ( 6-12 minggu)
2. Kronik NPB ( > 12 minggu)

Prediksi Prognosis:
- 60% penderita NPB bekerja kembali dalam 1 bulan
- 90% penderita NPB bekerja kembali dalam 3 bulan
- dengan intervensi minimal, penderita NPB mengalami
kemajuan pada minggu-minggu pertama

MYS 40
PENYEBAB NYERI PUNGGUNG BAWAH
I. MEKANIKAL (97%)
* Strain, sprain lumbal (70%)
* Proses degeneratif diskus dan facet (10%)
* Herniasi diskus (4%)
* Stenosis spinal (3%)
* Fraktur kompresi osteoporotik (4%)
* Spondilolistesis (2%)
* Fraktur traumatik (< 1%)
* Penyakit kongenital ( < 1%)

MYS 41
PENYEBAB NYERI PUNGGUNG BAWAH
II. NON MEKANIKAL (1%)
* Neoplasma (0,7%)
* Infeksi (0,01%) :
osteomielitis, abses epidural, abses
paraspinal, penyakit Pott
* Artritis inflamatori (0,3%) :
Ankylosing spondylitis, Psoriatic
spondylitis,
Sindroma Reiter
* Paget’s disease of the bone
MYS 42
PENYEBAB NYERI PUNGGUNG BAWAH
III. PENYAKIT ORGAN VISERAL (2%)
* Penyakit organ-organ pelvis (prostatitis,
endometriosis)
* Penyakit ginjal (nefrolitiasis, pielonefritis,
abses perinefrik)
* Aneurisma aorta
* Penyakit gastrointestinal (pankreatitis,
kolelitiasis)

SUMBER : POKDI NYERI PINGGANG INDONESIA

MYS 43
 HAL-HAL YANG MEMUNGKINKAN
TIMBULNYA NYERI PADA VERTEBRA
1. Iritasi cabang saraf besar yang menuju
ekstremitas
2. Iritasi cabang saraf kecil yang
mempersarafi vertebra
3. Ketegangan sepasang otot punggung
(m.erector spinae)
4. Kerusakan tulang, ligamentum atau
sendi
5. Ruang antar vertebra dapat menjadi
sumber nyeri

MYS 44
 RIWAYAT NYERI YANG PERLU
DIPERHATIKAN
• Onset nyeri (tiap hari, aktifitas)
• Lokasi nyeri (tempat spesifik, nyeri menjalar)
• Tipe dan karakter nyeri (tajam, kemeng)
• Faktor yang memperberat dan meringankan
• Riwayat medis, termasuk trauma, sebelumnya
• Stresor psikososial di rumah atau di tempat kerja
• Red flags !!! : usia > 50 tahun
demam
penurunan BB

MYS 45
 PEMERIKSAAN PADA VERTEBRA
• INSPEKSI : gaya berjalan, simetri, perilaku
penderita terkait keluhan nyerinya.
• PALPASI : vertebra, kelompok otot paraspinal
• PERKUSI : menilai adanya nyeri tekan
• PEMERIKSAAN UTK MENILAI FUNGSI :
* range of motion
* SLR test
* hiperekstensi tungkai
* refleks
* fungsi motorik dan sensorik

MYS 46
 PEMERIKSAAN PENUNJANG
• NEUROFISIOLOGIK :
- EMG
- somatosensory evoked potential
• RADIOLOGIK :
- foto polos
- mielografi, CT mielografi, CT-scan, MRI
• LABORATORIUM :
- LED, CRP, DL, UL

MYS 47
 INDIKASI FOTO POLOS PADA NPB
• Usia > 50 tahun
• Defisit motorik (+)
• BB menurun tanpa sebab yg jelas
• Dugaan Ankylosing spondylitis
• Penyalahgunaan obat dan alkohol
• Adanya riwayat kanker
• Suhu > 37,8oC
• Tidak ada perbaikan dalam 1 bulan

MYS 48
 NPB MEKANIKAL
STRAIN SPONDILO- HNP
SPINAL
OTOT LISTESIS
STENOSIS
Usia 20-40 20-30 30-50
> 50
Pola nyeri :
Lokasi awal Pinggang Pinggang Pinggang
Tungkai
Onset Akut Perlahan Akut
Perlahan
Berdiri + + -
+
Duduk - - +
-
Fleksi + MYS - + 49
-
4 BENTUK NYERI:
1. Nyeri Lokal
2. Nyeri Rujukan
3. Nyeri Menjalar
4. Nyeri Spasme otot sekunder

Penyebab nyeri tengkuk:

1. HNP Servikal
2. Spondilosis servikal
3. Shoulder hand syndrome
4. Whiplash Injury
5. Infeksi

MYS 50
 H N P SERVIKAL
* 5-10% … C5-C6 & C6-C7
* Parastesia & nyeri sesuai dengan dermatom
* Gerakan leher terbatas
* Medula spinalis tertekan …… UMN & LMN

Pemeriksaan:
1. Plain foto servikal
2. Myelografi servikal
Terapi :
3. M R I servikal ***** konservatif

MYS 51
 SPONDILOSIS SERVIKALIS
* TERSERING C5 &Cc6
* NYERI DAN KAKU TENGKUK
* NYERI RADIKULAR
* PENEKANAN RADIKS ANTERIOR …. PARESE
* PENEKANAN MS… myelopati (UMN & LMN)
* PENEKANAN arteri & vena spinalis anterior… Myelopati

PEMERIKSAAN:
1. Plain foto servikal Pengobatan:
2. Myelografi servikal *Konservatif:
3. MRI servikal - heat, massage
- servikal traction
- servikal collar
*Operatif

MYS 52
 SHOULDER HAND SYNDROME
* Sindroma akibat nyeri bahu sekunder:
- trauma, OA, cervical radiculitis
* Terapi sesuai kausa

WHIPLASH INJURY:
* Fleksi – Ekstensi ….. Rear end automobile collisions
* Gejala:
- nyeri tengkuk & kepala disertai mual & muntah
- nyeri radikular ke lengan
- parastesia & kaku
- adanya spasme otot

TERAPI:
1. Istirahat
2. Analgesik
3. Cervikal collar
MYS 53
 Hernia Nukleus Pulposus
• HNP adalah protrusi atau ekstrusi nukleus
pulposus bersama sebagian annulus
fibrosus ke dalam kanalis vertebralis atau
foramen intervertebralis
• Insidens : 1-2 % populasi
• Dapat terjadi dimana saja sepanjang
medulla spinalis
• Paling sering di daerah lumbal

MYS 54
 KARAKTERISTIK HNP AKUT
• Umur 30-50 tahun
• Lokasi nyeri : pinggang ke tungkai bawah
• Rasa nyeri : nyeri terbakar, parestesi di
tungkai
• Faktor yang memberatkan : meningkat
dengan membungkuk atau duduk,
berkurang dengan berdiri
• Tanda klinis : SLR (+), kelemahan, refleks
asimetri

MYS 55
 Distribusi lokasi HNP
• HNP lumbalis (paling >>)
L5-S1 (45-50%), L4-5 (40-45%)
ok jaringan fibrokartilagonya terutama
di
posterior lebih tipis dibanding diskus

intervertebralis lainnya
• HNP servikalis
C6-7 (69%), C5-6 (19%)
• HNP torakalis (jarang,
MYS < 1%) 56
 Gradasi HNP
• Protruded disk : penonjolan nukleus
pulposus tanpa kerusakan annulus
fibrosus
• Prolapsed disk : nukleus berpindah tetapi
tetap dalam lingkaran annulus fibrosus.
• Extruded disk : nukleus keluar dari
annulus fibrosus dan berada di bawah
ligamentum longitudinalis posterior.
• Sequestrated disk : nukleus telah
menembus ligamentum longitudinalis
posterior. MYS 57
 Gejala klinis
• HNP lumbalis :
* Nyeri radikuler pada bokong, paha, betis
dan kaki
* Postur vertebra kaku atau tidak normal
* Parestesi, parese dan gangguan refleks
tendon.
• HNP servikalis :
* nyeri radikuler di servikal yang
bertambah bila ekstensi leher,
berkurang bila lengan diangkat dan
diletakkan di belakang kepala
* Parestesi, pareseMYS
dan gangguan refleks 58
tendon.
 Diagnosa
• Pemeriksaan neurologis :
HNP lumbalis :
* Lasegue (straight leg raising) test
* Crossed Laseque (crossed SLR) test
* Femoral stretch (reverse SLR) test
HNP servikalis :
* Lhermitte test
* Spurling’s sign
* Shoulder abduction test

MYS 59
 Diagnosa
RADIOLOGIS
• Foto polos vertebra :
* informasi sangat terbatas
* diskus menyempit, skoliosis, lordosis
lumbal berkurang
• Mielografi
• CT atau CT-mielografi
• MRI (paling baik)

EMG/NCV : 90% abnormal setelah 1-2

minggu
MYS 60
 Terapi
• KONSERVATIF
* tirah baring
* tidur alas keras/ orthopaedic mattress
* analgetik
* traksi pelvis (kontroversial)
• OPERATIF
Indikasi :1. Konservatif gagal
2. Gangguan motorik progresif
3. Serangan berulang-ulang
4. Kompresi kauda equina
MYS 61
 STENOSIS SPINAL
• Adalah penyempitan kanal spinal
dengan kompresi akar saraf, dengan
atau tanpa keluhan
• Penyebab yang sering : hypertrophic
degenerative dari facet dan
penebalan ligamentum flavum

MYS 62
 KARAKTERISTIK STENOSIS SPINAL
• Usia > 50 tahun
• Lokasi nyeri : pinggang sampai tungkai
bawah, seringkali bilateral
• Sifat nyeri : menusuk, seperti menikam,
rasa seperti ditusuk jarum
• Faktor yang memperberat : bertambah
bila jalan, berkurang bila duduk
• Tanda klinis : sedikit penurunan ekstensi
vertebra

MYS 63
 TERAPI STENOSIS SPINAL
• Analgetik, OAINS
• Terapi fisik
• Injeksi kortikosteroid epidural
• Laminektomi dekompresi

MYS 64
 SPONDILOLISTESIS
• Adalah kelainan yang disebabkan
perpindahan ke depan satu corpus
vertebra terhadap vertebra di
bawahnya.
• Tersering pada L4-5
• Sering pada : orang yang sering
angkat beban berat, pemain sepak
bola, trauma
• Pada semua usia, tersering pada usia
MYS 65
tua
 GRADASI SPONDILOLISTESIS
Berdasarkan foto polos lateral, dibagi atas
menurut derajat beratnya pergeseran :
Grade 1 : 25%
Grade 2 : 25-49%
Grade 3 : 50-74%
Grade 4 : 75-99%
Grade 5 : 100% (slip seluruhnya, disebut
spondyloptosis)

MYS 66
 TERAPI SPONDILOLISTESIS
• Istirahat
• Hindari angkat berat
• Analgetik, OAINS
• Operasi

MYS 67
 SPONDILOSIS
• Adalah kelainan degeneratif yang
menyebabkan hilangnya struktur dan
fungsi normal spinal
• Penyebab utama : proses penuaan
• Lokasi dan percepatan proses
degenerasi bersifat individual

MYS 68
 TERAPI
• Konservatif (75% berhasil), meliputi :
* istirahat
* OAINS
* pelemas otot
* Pemanasan, stimulasi elektrik, lumbosakral
ortotik
* Olah raga
* Modifikasi gaya hidup
• Pembedahan (jarang)

MYS 69
THANK YOU

MYS 70