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TATA LAKSANAOPERATIF PADA PASIEN

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Nyeri Definition : Pain is an unpleasant

feeling that is conveyed to thebrain by sensory neurons.

Neck pain / cervical pain : is thesensation of discomfort in theneck area. Neck pain can resultfrom disorders of any of thestructures in the neck, includingthe cervical vertebrae andintervertebral discs, nerves,

muscles, blood vessels,esophagus, larynx, trachea,lymphatic organs, thyroid gland,or parathyroid glands.

medical-dictionary.thefreedictionary.com/cervical

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SpinothalamicTract

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Epidemiologi

Difficult to determine In Norway, (Bovim and colleagues) found a

prevalence of 13.8%.

In Finland, (Makela) discovered neck pain in 9.5% of

males and 13.5% of females. The United States' National Center for Health

Statistics reported 7.0% of men and 9.4% of womenhad neck pain in the period between 1976-1980.

Older patients, those involved in both mentally andphysically stressful jobs, and current smokers weremore likely to have neck pain.

More common in women

http://www.digital-doc.com/neckpain.htm

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Penyebab nyeri leher

Non-bedah

bedah

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Evaluasi klinis

Anamnesis, pemeriksaan fisikneurologis, penunjang

Defisit neurologis operasi Nyeri tanpa defisit neurologis terapi

konservatif 6 minggu

Riwayat demam, keringat malam, beratbadan turun, keganasan, infeksiearly diagnosis

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Defisit neurologis

Mielopati; defisit yang jelas,

mengganggu keseharian, cenderungmemburuk

Nyeri yang membaik dengan terapi

konservatif defisit neurologis jarangmembaik dengan penundaan / tanpapembedahan

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Tata laksana bedah

Anterior vs posterior

Anterior : melintasi struktur penting

(karotis, trakea, esofagus) Excellent exposure

Fusi

Dapat digunakan ada berbagai keadaan Minimal blood loss

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Tata laksana bedah

Anterior vs posterior

Posterior : disc is not as visible,

exposure not easy, Provide central / foraminal

decompression without fusion

foraminotomy, laminectomy, orlaminoplasty

Contraindication : loss of sagital

lordosis

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Radikulopati

Tujuan : Dekompresi radiks saraf

Anterior : lebih disukai, terutama bila

melibatkan 3 level, bilateral, perubahanlordosis servikal, nyeri leher kronik danberat

Posterior : unilateral, lebih dari 3 level,foraminotomi C7-T1 (sulit dicapai lewatanterior), obese, leher pendek, riwayatkegagalan ACDF

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Anterior ACDF Diseksi M. platysma

Membuka celah antara msternokleidomastoideus dan trakea-esofagus

Pelihara karotid sheath (a. carotis, v.jugular, n. laryngeus rekurens)

Exposure vertebra dan diskus

Eksisi diskus, osteofit

Bone graft

melebarkan foramen

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Posterior posteriorforaminotomi

Splitting m. paraspinal

Diseksi muskulus yang melekat pada

spina ekspose massa lateral dansendi faset

Burr untuk menipiskan daerah

foramen, tulang diangkat Fusi jarang diperlukan

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Outcome

ACDF untuk radikulopati 905success rate, most common procedure

3 level ACDF gangguan stabilitas Posterior foraminotomi : efektif, tidak

perlu fusi, less reliable

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Nyeri leher aksial

Fusimenghilangkan pergeseranantar segmen saat bergerak

Mengurangi nyeri akibat degeneratif Nyeri kronik tidak membaik dengan

terapi konservatif

ACDF vs posterior fusion

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Posterior cervical fusion

Ekspose massa lateral

Kapsul faset dilepaskan, sendi faset

dibuka, tulang rawan diangkat Bone graft pada sendi untuk fusi

Lateral mass screw

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Outcome

Suboptimal

Luaran klinis memburuk dengan makin

banyak leel yang dilakukan fusi Nyeri pasca operasi tersisa

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Myelopati

Dekompresi medulla spinalis(multiprosedural)

Protruding disk ACDF OPLL

Anterior: pengangkatan osteofit, PLL,

korpektomi Posterior : laminektomi +/- fusi,

laminoplasti

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Anterior vs posterior

Anterior Posterior

< 3 level > 3 level, lordosis

baik> 3 level, kifosis

Improvement85%

99%

66%laminektomi ;92% laminoplasti

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References

1. Ahn NU, Ahn UM, andersson GBJ, An HS. Operatie treatment of the patient with neckpain. Phys Med Rehabil Clin N Am 14 (2003) 675-92