1. nyeri punggung bawah pada hernia nukleus pulposus.ppt

7/24/2019 1. Nyeri Punggung Bawah Pada Hernia Nukleus Pulposus.ppt

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Nyeri Punggung Bawah

Pada Hernia Nukleus Pulposus

ALDY S. RAMBE

Departemen NeurologiFK-USU/

RSUP H. Aam Mali!


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DEF"N"S"#

N$eri Punggung Ba%a& 'NPB( aala&N$eri $ang ira)a!an i aera& punggung

*a%a&+ apat merupa!an n$eri lo!almaupun n$eri rai!ular atau !euan$a

'Po!i N$eri Pero))i(


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EPIDEMIOLOGI

NPB:

* Merupakan salah satu dari 10 alasan pasien

mengunjungi Dokter* Prevalensi: 7.5!7" dari populasi #$%&'

* Prevalensi teringgi pada rentang usia (5)0

tahun

* 0" orang de+asa pernah mengalami NPB akut* ,ahun 1--1 di $%& diperkirakan /5 milar tahun


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PENYEBAB NYERI PNGGNG BA!AH

I" ME#ANI#AL $%&'(

) *+rain, sprain lu-.al $&/'(

) Proses degenera+i0 diskus dan 0a1e+ $2/'(

) 2erniasi diskus interverte3ralis$3'() *+enosis spinal $4'(

) 5rak+ur ko-presi os+eoporo+ik $3'(

) *pondilolis+esis $6'(

) 5rak+ur +rau-a+ik $7 2'() Penyaki+ kongeni+al $ 7 2'(


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II" NON ME#ANI#AL $2'(

) Neoplas-a $/,&'(

) In0eksi $/,/2'( 8

os+eo-ieli+is, a.ses epidural, a.ses paraspinal,penyaki+ Po++

) Ar+ri+is in0la-a+ori $/,4'( 8

Ankylosing spondyli+is, Psoria+i1 spondyli+is,

*indro-a Rei+er

) Page+9s disease o0 +he .one


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III" PENYA#I: ORGAN ;I*ERAL $6'(

) Penyaki+ organal $ne0roli+iasis, pielone0ri+is, a.sesperine0rik(

) Aneuris-a aor+a

) Penyaki+ gas+roin+es+inal $pankrea+i+is, koleli+iasis(

SUMBER : POKDI NYERI PINGGANG INDONESIA


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Hernia Nukleus Pulposus $HNP(

? HNP adalah pro+rusi a+au eks+rusi nukleus

pulposus .ersa-a se.agian annulus 0i.rosus ke

dala- kanalis =er+e.ralis a+au 0ora-en

in+er=er+e.ralis? Insidens 8 2


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DISCUS INTERVERTEBRALIS


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Herniated discHerniated disc

Hernia+ed dis1


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HNP Lu-.alis

? :he earlies+ 1hange in +he NP and A5 are pro.a.ly .io1he-i1al and

-ay .e par+ o0 aging

? *uperi-posed +rau-a a11elera+es +hese degenera+i=e 1hanges

? :he la+ers o0 +he A5 separa+e and 0or- 1ir1u-0eren+ial +ear, leads +o

radial +ears"? NP -ay e@+rude produ1ing dis1 hernia+ion or prolaps

? Mul+iple +ears produ1e weakening and 1ir1u-0eren+ial .ulging o0 +he

A5 wi+h loss o0 dis1 heigh+

Further disc narrowing results from aging of the NP, which

changes from gelatinous consistency int the childhood to a

fibrotic consistency in adulthood


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#ARA#:ERI*:I# HNP LMBALI* A#:

? -ur 4/


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Is1hialgia $s1ia+i1a(


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Dis+ri.usi lokasi HNP

? HNP lu-.alis $paling CC(

L


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GradasiHNP


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Diagnosis HNP : Pemeriksaan Motorik

Clinical symposia-ciba, vol 32, no.6,

1980


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Diagnosis HNP : Pemeriksaan Sensorik


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Diagnosis HNP : Test provokasi

Lumbar HNP 8* Lasegue (straight leg raising) test

A posi+i=e *LR +es+ is a sensi+i=e indi1a+or o0 ner=e

roo+ irri+a+ion $sensi+i=i+y %'(",May .e posi+i=e wi+h dis1 pro+russion, in+raspinal+u-or or in0la--a+ory radi1ulopa+hy

) !r"sse# Lase$ue (%r"sse# SLR) test

Less sensi+i=e .u+ highly spe1i0i1"

) &e'"ral stret%h (reerse SLR) test"

May de+e1+ an L6


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TEST LASEGUE


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HNP Diagnosis

4&D6689& ;&MN&,6N :? Plain verte3ral narro+ing? s>oliosis? lordosis lum3al

? Melograph

? 9, or 9,melograph

? M4 : the 3est imaging stud

M8N9@: -0" a3normal a=ter 1/ +eeks


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MRI s1an shows L3


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HNP :herapy 8 onser=a+i=e

* .ed res+ 8 -a@ 6 days re1o--ended) Phar-a1o+herapy 8

< N*AID

< shor+ 1ourse o0 1or+i1os+eroid 0or a1u+e hernia+ed

dis1 $1on+ro=ersial(< -us1le rela@an+

< 0or neuropa+hi1 pain 8 ga.apen+in, ' lido1aine

pa+1h, +ra-adol, :A"

) Nonphar-a1ologi1 +herapy 8

< hea+, i1e, -assage, s+ress redu1+ion, a1+i=i+y li-i+a+ion,

pos+ural -odi0i1a+ion, physi1al +herapy progra-

< so0+ 1er=i1al 1ollar or lu-.ar 1orse+


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HNP :herapy 8 Opera+i=e

:he 0ew a.solu+e indi1a+ions 8

2" Marked -us1ular weakness per+aining +o a ner=e roo+

or roo+s"6" Progressi=e neurologi1 de0i1i+s"

4" auda eFuina syndro-e wi+h urinary sy-p+o-s

3" Pain +ha+ has e@is+ed 0or -ore +han 3 -on+hs, has no+

responded +o 1onser=a+i=e +rea+-en+, and in+er0ereswi+h nor-al 0un1+ion"


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MAULI ATE GODANG

1. nyeri punggung bawah pada hernia nukleus pulposus.ppt

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