K6 - NR - Back Pain
K6 - NR - Back Pain
Sinurat, SpS
Dept Neurologi FK-USU MEDAN
2014
Symptoms :
- Muscle ache or shooting
- Limited range of function
- Inability to stand straight
Types :
- Acute Vs Chronic
- Lower Back Pain
- Middle Back Pain
- Upper Back Pain
- Accidents
- Arthritis
- Muscle strains
- Sport injuries
- Nerve problems
- Muscular problems
- Degenerative disc disease
Age : middle age
Sex : male
Family history
Previous : Back injury, surgery
Pregnancy
Congenital spine problems
Lack of exercose
Longerm medicine that weaken bones
Poor posture
Overweight
Stress
smoking
Definisi: nyeri yang dirasakan di daerah
punggung bawah, dapat merupakan nyeri
lokal maupun nyeri radikuler atau keduanya
Incidens : 60-90% lifetime incidens
5 % annual incidens
90% LBP resolve without treatment within 6-12
weeks
40-50% resolves within 1 week
75% with nerve root involvement can resolve in
6 months
LBP leading cause of disability of adults < 45 yo
Third cause of disability in >45 y o
- Lumbar strain
- Disc bulge/protrusion/extrusion/producing
radiculopathy
- Degenerative disc disease
- Spinal stenosis
- Spondyloarthropathy
- Spondylosis
- Spondylolisthesis
- Sacro-iliac dysfuntion
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
1. NPB Akut : < 6 minggu
2. NPB Subakut : 6 -12 minggu
3. NPB Khronik : > 12 minggu
I. MEKANIKAL
* Strain, sprain lumbal
* Proses degeneratif diskus dan facet
* Herniasi diskus
* Stenosis spinal
* Fraktur kompresi osteoporotik
* Spondilolistesis
* Fraktur traumatik
* Penyakit kongenital
II. NON MEKANIKAL
* Neoplasma
* Infeksi : osteomielitis, abses epidural, abses
paraspinal, penyakit Pott
* Artritis inflamatori : Ankylosing spondylitis,
Psoriatic spondylitis, Sindroma Reiter
* Paget’s disease of the bone
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
NEUROFISIOLOGIK :
- EMG
- somatosensory evoked potential
RADIOLOGIK :
- foto polos
- mielografi, CT mielografi, CT-scan, MRI
LABORATORIUM :
equina
Disk herniation
Spinal stenosis
Spinal tumor
Inflammatory condition
Cauda equina syndrome is a surgical
emergency (surgical decompression)
Treatment underlying causes of CES
Myelography
CT or CT-myelography
MRI : the best imaging study