Kelainan Tulang Belakang (Dokter Umum).pdf

Tulang Belakang

1. dr. RismaKarlinaP, Sp.S
PENYAKIT TULANG BELAKANG

19. Jarang mengenai hanya white matter (ct. Lesi kolumna posterior) atau hanya gray
matter (ct. Poliomyelitis)
Lebih sering mengenai gray dan white matter
SPINAL CORD LESION

20. SYRINGOMYELIA

21. Pembentukan satu atau lebih kantong cairan pada medula spinalis
Etiologi: idiopatik, kongenital
Paling sering mengenai daerah cervical
Klinis: analgesia dan termanastesia daerah bahu dan ekstrimitas atas,
paraparesis spastik, gangguan berkemih, BAB dan fungsi seksual
SYRINGOMYELIA

22. Etiologi: trauma>>, infeksi
atau inflamasi
Spinal Shock (trauma>>)
(tanda LMN)
Klinis:
Tergantung tinggi lesi (tanda
UMN)
COMPLETE SPINAL TRANSECTION

23. COMPLETE SPINAL TRANSECTION

24. EpikonusKonusKauda equina
L4-S2S3 kebawahRadiksdan saraf tepi lumbar
dan sakral
Paresis spastikatau flaccid
ekstrimitas bawah
Pasresis (+/-)Radikular pain>>
APR(-)APR (+)Flaccid paralisa
KPR (+)KPR (+)KPR (-), APR (-)
Defisit sensorisL4-S5 Defisit sensorisL4-bawah
BAKdan BAB reflexiveGangguanotonom (+)
Gangguan sexual
Gangguan berkeringat

25. CONUS VS CAUDA
ConusCauda
Sudden and bilateral onsetGradualand unilateral onset
Radicular pain less prominentRadicular pain more prominent
More low back painLess low back pain
Symmetric, distal, hyperreflexic
paresis
Asymmetric, areflexic paraplegia
Symmetric, bilateral,typically
perianal area sensory loss,
sensory dissociation occurs
Asymmetric, unilateral,typically
saddle area, no sensory
dissociation
Early spinctersignsLate spinctersigns

26. DORSAL ROOT SYNDROME

27. RADICULAR SYNDROME (NERVE ROOT SYNDROME)

28. Lesi RADIK SPINAL
1.CRS= Cervical Root Sindrome
2.HNP Cervical
3. HNPLumbal
4. Canal StenosisLumbal

29. Lesi RADIK CERVICAL
HNPLateral
CRSok Spur Formation Spondylosis

30. Komposisi massa “ intervertebral disc”
nucleus pulposusdan annulus fibrosus

31. Normal :
Tekananditerimanucleus pulposusdan
annulus fib. merata( A )
Tidaknormal
( hidrasikurang, hialinisasi,
Robekanannulus )
Tekananditeruskantidaksamarata ( B )
HNP ( C )
( Hernia Nucleus Pulposus
HNP= Hernia Nucleus Pulposus

32. HNPLumbalis
LBP +
Ischialgia
Nyeri Radikuler

33. HNP Lumbalis

34. HNP
Lumbalis

35. Lesi radiks C5:
--Motorik :m.Deltoid, Supraspinatus , Biceps
--Sensorik :defisit sensorik lengan atas radial
--Reflek :-

36. Lesi radiks C6:
-Motorik :m.Biceps , Dorsum tangan
-Sensorik :lengan bwh bag radial sp jari 1,2
-Reflek :Periost. Radii , Biceps ( C5-6)

37. Lesi radiks C7 :
-Motorik :-m.Triceps ( ekstensi siku )
-Volar Fleksi tangan -Ekstensi jari-2
-Sensorik :Jari 3
-Reflek : Triceps

38. Lesi radiks C8,
motorik:kelemahan fleksi pergel. aposisi jari-2
sensorik :defisit lgn bwh sisi ulnar, jari 4,5
reflek ( -)

42. DIAGNOSA HNP
1.Ischialgia/sciatica: nyeri pinggang bawah, menjalar ke
paha atau sp tungkai bawah/kaki (tergantung radiks yg
terkena = atau nyeri radikuler)
Rasa tebal dan kesemutan sesuai radiks
Paling sering HNP : L5-S1, kmd L4-L5
Nyeri makin berat : aktifitas, peregangan,batuk,bersin
2.Lasequetes (+)= straight-leg raising test : nyeri radikuler
saat tungkai diangkat £30-40°
Naffzigertes (+)
2.Motorik, sensorik danreflek: sesuai segmen radiks
3.X-foto Lumbosacral AP/lateral : intervert space
menyempit

43. Lanjutan Diagnosis HNP
-Caudografi : Tampak level disk yang menonjol
-Computed tomography ( CT scanning )
atau MRI lumbal

44. INTRAMEDULLARY VS
EXTRAMEDULLARY
Intradural intramedullary:
astrocytomas, ependymomas,
hemangioblastomas (primary spinal
tumours)
Intradural extramedullary:
Meningiomas
nerve sheath tumours (schwannomas and
neurofibromas)
Epidural: metastases
http://www.emory.edu/ANATOMY/AnatomyManual/back.html

45. INTRAMEDULLARY VSEXTRAMEDULLARY
IntramedullaryExtramedullary
Poorly localized burning pain Prominent radicularpain
“sacral sparing”Early sacral sensory loss
Corticospinal tract signs
appearlater
Early spastic weaknessin legs
Usually rapid progression
(usually malignant lesion)
Usually slow progression
(usually benign lesion)

46. A urinary tract dysfunction
Condition may be congenital or acquired
No cure but can be managed
Most cases managed with medication and intermittent catheterization
The primary goal of the Urologist is to maintain and preserve renal
function!
NEUROGENIC BLADDER

47. NEUROGENIC BLADDER
Spina Bifida
Multiple Sclerosis
Parkinson Disease
Cauda equina syndrome
Paralytic syndrome
Stroke complications
Brain injury
Spinal cord injury
Diabetes mellitus
Heavy metal poisoning
Acute infections
Spinal cord tumors
Syphilis
Benign prostatic hyperplasia

48. NEUROGENIC BLADDER
Sensory –posterior columns of the spinal cord or afferent tracts leading from
the bladder.
Motor paralytic bladder –damage to motor neurons.
Uninhibited –incomplete lesion above S2.
Reflex -complete lesion above S2.
Autonomous -cauda equnia lesions.

49. NEUROGENIC BLADDER
Bladder functions will change.
Goals and priority will change.
Risks for interventions will change.

55. NEUROGENIC BLADDER
Hypotonic (flaccid) –damage to the spinal cord due to spinal cord lesions.
These bladders are distended with overflow.
Spastic (contracted) –caused by brain or upper spinal cord damage that result
in paraplegia or quadriplegia. These bladders do not distend and leak.

56. NEUROGENIC BLADDER
Symptoms:
UTI
Stone disease
Incontinence
Fever
Chills
Hematuria
Kidney injury

57. NEUROGENIC BLADDER
Clinical presentations
Frequency
Nocturia
Incontinence -urge, over flow
UTI
Retention

58. NEUROGENIC BLADDER
Hyperreflexic
Hyporeflexic
Areflexic

59. NEUROGENIC BLADDER
Complications:
Sepsis
Hydronephrosis
Renal failure

60. NEUROGENIC BLADDER
Evaluation:
S&S with UTI hx.
Urgency and the relationship to incontinence
S&S of obstruction
Voiding diary
Awareness of full bladder
Fecal incontinence
Erection
GYN hx.

61. NEUROGENIC BLADDER
Exam:
Neurologic
Sphincter tone
Bulbocavernosus reflex
Anal reflexes
Exam vaginal wall at rest and with valsalva
Vaginitis
Proplase
Levator tone

62. NEUROGENIC BLADDER
Tests:
PVR
Labs –cbc, bmp, ua, c&s
Urodynamic
CT or IVP
US
Cystoscopy
RUG

63. NEUROGENIC BLADDER
Treatments:
Anticholinergics
Alpha-adrenergic stimulation
Intermittent self-catheterization
Surgical treatments
Pelvic floor re-hab
Bladder training
Electrical stimulation
Botox injections