Professional Documents
Culture Documents
injury
Sub Bagian Bedah Saraf
Laboratorium/SMF Bedah
RSUD Dr Moewardi Surakarta
Insiden
2 per 100.000 populasi
50% mengenai regio servikal
50% thorakal, thorakolumbar dan lumbosakral
Tujuan
Bisa mengevaluasi dugaan cedera spinal cord
Melakukan penatalaksanaan yang tepat
Bisa menentukan rujukan yang tepat
Key questions
Kapan kita mencurigai SCI?
Bagaimana kita mengkonfirmasi ada atau
General Principles
of Trauma
Primary Survey
Airway (with C-spine protection)
Breathing and ventilation
Circulation (with hemorrhage control)
Disability - neurologic status
Exposure and environment
Resuscitation
Other studies and monitors
Secondary survey
Pemeriksaan
Klinis neurologis
Elektroneurofisiologik
X-ray polos
Myelografi
CT-myelografi
CT scan
MRI
Foto polos
vertebra
CT Scan :
Bisa mengidentifikasi dan menunjukkan posisi
fragmen fraktur terhadap kanalis spinalis
CT-myelografi atau MRI :
Memberikan informasi tambahan, terutama
keadaan struktur soft tissue : HNP, hematoma,
ruptur ligamen, tumor, abses dll
X-ray polos
Myelografi
CT Scan
CTmyelografi
MRI
Penatalaksanaan
Evaluasi ABCDE
Jika perlu resusitasi
Imobilisasi pasien
secara tepat
Jangan terlambat
mentransfer!
Penatalaksanaan
Medical problems:
initial immobilization
prolonged rehabilitation
significant readjustment in lifestyle
potential complications in the chronic stages
injury
Pharmacologic Treatment
of Spinal Cord Injury
Methylprednisolone:
decreasing lipid peroxidation
stabilizing cell membranes
enhancing spinal cord blood flow
decreasing vascular permeability & edema
National Acute Spinal Cord injury Study (NASCIS) II trials:
methylprednisolone (within 8 hours): significantly better neurologic
recovery
after 8 hours: worst outcome (relatively high rate of complications)
NASCIS III: improved recovery when tx extended to 48 hours
(if drug therapy was started within 3 to 8 hours)
Pharmacologic Treatment
of Spinal Cord Injury
Dosage:
30 mg/kg of IV methylprednisolone (for 1 h)
followed by 5.4 mg/kg (administered over the next 23
h)
if administered within 3 h of injury
when is initiated 3 to 8 h after injury: maintained for 48
h
Fractures of the
Cervical Spine
Most fractures: do not
require surgery
Nonsurgical management:
without neurologic deficit
& stable
More stable injuries:
soft collars
hard collars
cervicothoracic braces
sterno-occipital
mandibular immobiliser
Surgical Management
Internal fixation:
early mobilization &
rehabilitation,
more thorough decompression
Bahan
bacaan
Thank You