Curriculum Vitae

PLACE AND DATE OF BIRTH

Jakarta, March 25th 1979
EDUCATION
 Neurosurgery, Padjadjaran University, Bandung, 2004 - 2010
 M.D. Faculty of Medicine, Diponegoro University,
Semarang, 1997 - 2001

POST GRADUATE EDUCATION AND TRAINING

 Hands-on Workshop Interventional Pain Management
Procedure, Bandung, 2016
 The International Spine Surgeon Training Course, INHA
University Hospital, Korea, 2015
 SELD Educational Program, Cham Podonamu Hospital,
Korea, 2015
 Spine Fellowship: Liaquat National Hospital, Karachi,
Pakistan, 2014

Dr Stephanus Gunawan, SpBS

POST GRADUATE EDUCATION AND TRAINING Curriculum Vitae

 The 3rd Cadaver Workshop: Interventional Pain

Management Level 2, Jakarta, 2013

 Pain Management Level 1 Workshop on Indonesian

Society of Neurological Surgeons Annual Meeting,

Surakarta, 2013

 Basic Intracranial Neuroendoscopy Workshop on

Indonesian Society of Neurological Surgeons Annual

Meeting, Surakarta, 2013

 Endovascular Workshop on Indonesian Society of

Neurological Surgeons Annual Meeting, Surakarta, 2013

 Basic Spinal International Course Asia M-E.A., Bangkok,

Thailand, 2011

Dr Stephanus Gunawan, SpBS

POST GRADUATE EDUCATION AND TRAINING Curriculum Vitae

 Continuing Medical Education (CME) Event, The 1st Indonesia

Hands on Cadaver Dissection Workshop & 3rd Wooridul

International Cadaver Workshop: Minimally Invasive Spine

Surgery, Jakarta, 2011

 Pre-Congress Cadaver Hands-on Workshop on

“Foraminal and Endoscopic Spinal Anatomy,

4th ISMISS Congress in Turkey on Minimal Invasive

Spine Surgery and Interventional Treatments, Antalya,

Turkey, 2010

 Interventional Pain Workshop: Level 1, Surabaya, 2011

 Workshop WFNS Skull Base Course (Cadaveric Dissection),

Jakarta, 2010

Dr Stephanus Gunawan, SpBS

 IPM or SURGERY?
NECK AND BACK PAIN

2nd Pain Management in Daily Practice

December 2nd, 2018. Pangeran Hotel, Pekanbaru
Interventional Pain Management
• Neck pain
- Cervical epidural steroid injection
- Cervical neuroplasty
- Cervical transforaminal injection
- Cervical facet block
• Back pain
– Lumbar transforaminal epidural steroid injection
– Lumbar facet joint block
– Lumbar neuroplasty
NECK PAIN
Cervical epidural steroid injection
Indications:
• Radicular pain: - disc herniation
- central / foraminal stenosis
- spondilolistesis
• Contraindications: - Previous cervical surgery
- febrile
- coagulopathy
- local infection
Cervical neuroplasty
• Indications: - Failed neck surgery syndrome
- Epidural fibrosis
- Cervical radiculopathy
- Cervical disc bulges
- Cervical osteophytes
- Lateral recess stenosis
• Contraindications: - Local infection
- Coagulopathy
- Unstable cervical spine
- Syrinx
- Significant central spinal stenosis
Cervical transforaminal injection
• Indication:
- nonsurgical cervical radicular pain syndromes
(disc herniation, spinal stenosis)
• Contraindications:
- severe spinal stenosis
- syrinx
- spinal instability
- infection
- coagulopathy
Cervical facet block
• Indication: - cervical facet syndrome

C2-3
C3-4
C4-5
C5-6 C6-7
Cervical facet block
• Contraindications:
- Patients who have had inadequate pain relief
or relief for less than 3 months following a
previous neurotomy.
- When appropriate, pacemaker and ICD
equipment must be deactivated prior to RF
neurotomy.
• Cervical facet block

Before contrast After contrast

BACK PAIN
Lumbar transforaminal epidural
steroid injection
• Indication: radicular pain resulting from
irritation and inflammation of the dorsal root
ganglion and other neural structures in its
vicinity.
• Contraindications: significant bleeding diathesis,
systemic or local infections at the procedure
site, mental state making communication
difficult, and uncooperative
Lumbar facet joint block
• Indication: to determine whether specific
lumbar zygapophyseal joints are the cause of a
patient’s lower back pain.
• Contraindication:
- Systemic or local infection at proposed
injection site
- Bleeding diathesis,
either primary or due
to anticoagulant use
- Pregnancy
Lumbar epidural steroid injection
Indications:
• Radicular pain: - disc herniation
- central / foraminal stenosis
- spondilolistesis
• Contraindications: - febrile
- coagulopathy
- local infection
C-arm
SURGERY
Cause of pain
• Trauma
• Anatomy anomaly
• Infection
• Neoplasm
• Degenerative
TRAUMA
• Fraktur kompresi dan burst fracture: cervical
Anterior Corpectomy and Fusion
(ACCF)
Fraktur kompresi cervical
Laki-laki, 40 th, dengan
keluhan nyeri leher
dan lumpuh kedua
kaki

CT Scan
CT SCAN POST ACCF
Fraktur kompresi: Lumbal
• Jatuh terduduk
Laki-laki, 32th, keluhan nyeri pinggang
dan sulit BAK dan BAB
MRI Lumbal
Laminektomi dekompresi + stabilisasi posterior
• Laki-laki, 42th, dengan
keluhan nyeri
pinggang
• Laminektomi
dekompresi +
stabilisasi dengan
pedicle screw
• Spondilolistesis: - cervical
Spondilolistesis Lumbal
 Spondilolistesis
The indications for surgery:
• Documented progression of a slip beyond 25%
• Presentation with a high-grade slip (>50%)
• Intractable pain or neurologic symptoms
• Progressive postural deformity or gait
abnormality
KELAINAN ANATOMI: Arnold Chiari Malformation

4 Februari 2015 17 Februari 2016

INFEKSI: Spondilitis TB
Laki-laki,
24 th,
keluhan
nyeri
punggung
dan kebas
di kedua
kaki
TUMOR
• Extradural
• Intradural extramedular
• Intramedular
• Laki-laki,
39th,
dengan
keluhan
nyeri
mengikat di
dada dan
punggung,
dan lemah
kaki kanan.

Pre Op Post op
DEGENERATIVE
• OPLL
• Disc degeneration
• Facet hypertrophy
• Ligamentum flavum hypertrophy
CERVICAL
ANTERIOR
• ACDF
• ACCF
Herniated Disc - Cervical
X-RAY POST ACDF
OPLL
POSTERIOR
• Laminoplasty
Herniated Disc - Lumbal