referat mielopati servikal.pptx

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W I N D A S E T Y O W U L A N

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R S U D K O T A B E K A S I

MIELOPATI SERVIKAL

Pembimbing: Dr. Rudy Yunanto, Sp.BS

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PENDAHULUAN

• Cedera medula spinalis→ penyebab utama

disabilitas neurologis akibat trauma

• 10.000 kasus baru per tahun di Amerika (TheNational 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 dalamcanalis 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

MIELOPAT I SERVIKAL

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DEFINISI

Gangguan fungsionaldan 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 karenaperkembangannya yang lambat dan bertahap

• Gejala dari kompresi yang terjadi*:

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•Nyeri, parestesi

Gejala sensorik

•Kelumpuhan

Gejala motorik

•Gangguan respirasi, sirkulasi, miksi, dan defekasi

Gejala otonom

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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

•Keterampilan menurun (kesulitan

menulis), perubahan sensasi sertakelemahan lengan

Regio C3 –  C6

•Sindroma spastisitas dan hilangnyaproprioseptik tungkai

Regio C6 –  C8

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PEMERIKSAAN FISIK

• Kelemahan ekstremitas

• Spastic gait

• Status neurologis

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Tanda

UMN

Hipertonus

Hiperrefleks

Klonusankle (+)

Babinski (+)

Hoffman(+)

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KLASIFIKASI

• Berdasarkan ada/tidaknya fungsi yangdipertahankan di bawah lesi

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Karakteristik   Lesi Komplit  Lesi Inkomplit Motorik   Hilang di bawah lesi  Sering (+) Protopatik (nyeri, suhu)  Hilang di bawah lesi  Sering (+) Propioseptik (joint

position, vibrasi) Hilang di bawah lesi  Sering (+) 

Sacral sparing  Negatif  Positif Ro vertebra  Sering fraktur, luksasi, atau

listesis Sering normal 

MRI  Hemoragi (54%), kompresi

(25%), kontusi (11%) Edema (62%),

kontusi (26%),

normal (15%) 

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KLASIFIKASI

• EuropeanMyelopathy Score

• 17-18 : normal

• 13-16 : grade 1

• 9-12 : grade 2

• 5-8 : grade 3

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Score  Definition Gait Function 

1

2

3

4

5 

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 Bladder and Bowel Function 

1

2

3 Retention, no control over bladder and/or bowel function

Inadequate micturition and urinary frequency

Normal bladder and bowel function Hand Function 

1

2

3

4 

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 Proprioception and Coordination 

1

2

3 

Getting dressed only with aid

Getting dressed clumsily and slowly

Getting dressed normally Paraesthesia/Pain 

1

2

3 

Invalidity due to pain

Endurable paraesthesia and pain

No paraesthesia and pain 

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KLASIFIKASI

• Nurick’s Score

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Grade  Level of Neurological Involvement Grade I

Grade II

Grade III

Grade IV

Grade V 

No difficulty in walking

Mild gait involvement not interfering with employment

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 fungsisensoris dan motoris

• Terapi konservatif:

•

Imobilisasi→ soft collar neck• Metilprednisolon high dose

30 mg/kgBB IV dalam 8 jam pertama dilanjutkan 5.4 mg/kgBB/jamselama 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

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Group A Complete Motor and sensory loss belowthe lesion

Group B Sensory Incomplete Some sensory preservationbelow the zone of injury

Group C Motor Incomplete Motor and sensory sparing, butthe patient is nonfunctional

Group D Motor Incomplete Motor and sensory sparing and

the patient is functional (standsand walks)

Group E Complete functional recovery Reflexes may be abnormal

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PROGNOSIS

• Sebuah penelitian prospektif selama 27 tahunmenunjukkan bahwa rata-rata harapan hiduppasien cedera medula spinalis lebih rendahdisbanding populasi normal. Penurunan rata-ratalama harapan hidup sesuai dengan beratnyacedera. Penyebab kematian utama adalahkomplikasi disabilitas neurologi yaitu: pneumonia,emboli paru, septikemia, dan gagal ginjal.

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DAFTAR PUSTAKA

1. York JE. Approach to the patient with acute nervous system trauma. Best Practice ofMedicine. September 2000.

2. Young W. Spinal cord injury levels and classification. Care Cure Community. Keek Centre forCollaborative Neuroscience. 2002.

3. Hoppenfield S. Orthopaedic neurology: a diagnosis guide to neurologic levels. JB LippincottWilliams. 1977.

4. FSIP. Spinal cord injury facts: statistics. Foundation for Spinal Cord Injury Prevention, Care andCure. 2001.

5. Pinzon R. Mielopati servikal trauma: telaah pustaka terkini. Cermin Dunia Kedokteran 154;2007: 39-42.

6. Hansen JT. Netter’s clinical anatomy. 2nd Ed. Philadelphia; Saunders Elsevier: 2010. p.60-3.7. Sherwood L. Human physiology from cells to systems. 7th Ed. California; Brooks/Cole: 2010.

p.172-7.

8. Klezl Z, Coughlin TA. Cervical myelopathy. 2013. Available at:http://www.boneandjoint.org.uk/content/focus/cervical-myelopathy. Accessed on February19, 2014.

9. Department of Neurosurgery Columbia University. Cervical myelopathy. 2014. Available at:

http://www.columbianeurosurgery.org/conditions/cervical-myelopathy/. Accessed onFebruary 20, 2014.

10. Young W. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction inolder persons. Am Fam Physician. 2000;62(5):1064-70.

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