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Neurologico Spinale Medico Chirurgico
Published by Universitas Udayana
ISSN : -     EISSN : 26212064     DOI : https://doi.org/10.36444/nsmc
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience
Neurologico Spinale Medico Chirurgico (NSMC) is an open-access, single-blind peer-reviewed journal, published by Indonesian Neurospine Society (INSS) under the flag of Indonesian Neurosurgery Society (INS) and Faculty of Medicine, Udayana University. NSMC publishes articles which encompass all aspects of basic research/clinical studies. The journal facilitates, bridge and integrate the intellectual, methodological, and substantive diversity of medical knowledge, especially in the field of surgery, neurology, neurosurgery, spine, neuroanesthesia, medicine, and health. The journal appreciates any contributions which promote the exchange of ideas between practising educators and medical researchers all over the world.
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 36 Documents
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Search results for , issue "Supplementary Issue - Conference Abstracts" : 36 Documents clear
Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment Nur Setiawan Suroto
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.
Spinal Arachnoid Cyst in Children Wihasto Suryaningtyas
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.
Tethered Cord Syndrome Samsul Ashari
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Tethered cord syndrome (TCS) is a clinical condition of various origins, which comprises of progressive neurological, urological, and orthopaedic dysfunction, because of congenital fixation or tethering of the distal spinal cord by the terminal filum. It is believed that, if the filum elasticity is compromised by either fatty infiltration or abnormal thickening, the spine movement may cause stress upon the conus, resulting in TCS. Patients with symptomatic TCS can present with a wide variety of signs and symptoms in combination with cutaneous, orthopaedic, spinal, anorectal, and urological abnormalities. The common clinical presentations include the presence of cutaneous signs associated with open septal defects, neurogenic bladder with incontinence or urinary tract infection, leg or foot weakness, numbness and/or spasticity, differences in leg or foot length, deformities of the foot, spinal deformities, and back and leg pain. Neuroimaging is used to confirm when there is suspicion of TCS. Magnetic resonance imaging is the modality of choice in visualizing the level of the conus medullaris and for identifying a thickened and/or fatty filum. The fundamental goals of surgical intervention in TCS are to prevent future deficits in the asymptomatic patient and to improve or stabilize deficits in the symptomatic patient. These two goals are based on the fact that sectioning of the terminal filum can be done safely with minimal risk and a very low rate of morbidity. The reported complications of surgery are cerebrospinal fluid leakage (most common), wound infection, meningitis, bladder dysfunction, and neurological injury.
Controversies in Managing of Thoracic-Lumbar Upper Burst Fractures Sahat Edison Sitorus
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Upper burst fracture of Th12-L1 has unique anatomy because it contains lower spinal cord, medullary cone, and diaphragm which separates between the thoracic and lumbar spine. The presence or absence of neurologic deficit is the single most important factor in the decision making. The presence of profound but incomplete neural deficit in association with canal compromise represents an urgent indication of surgical decompression. Antero-lateral direct decompression with trans-thoracic trans-pleural– retroperitoneal approach given the proximity the cord and conus is the most effective method, with inter-vertebral instrumentation with or without lateral fixation or posterior instrumentation.
Delayed Neurological Deficit after Traumatic Odontoid Fracture Yesaya Yunus; Julius July
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly. If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy. We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation. Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients. All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture.
Surgical Tactics to Cervical Myelopathy and Radiculopathy Junichi Mizuno
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

There are 2 ways to approach the cervical spine, the anterior approach and the posterior approach. When conservative treatments fail, surgical management is brought to the table. The key issues to determine the approach include good outcome, less axial pain, and preservation of the motion. Minimally invasive techniques can provide good outcome with fewer complications. Anterior decompression and fusion (ACDF) is the gold standard technique since 1950s, and ACDF is now performed under the microscope. Skin-fold incision, longitudinal dissection of the platysma and gentle retraction of the trachea, esophagus, as well as vessels, expose the anterior surface of the vertebral bodies. After satisfactory decompression, the interbody fusion is performed. Key-hole discectomy is less-invasive procedure without metal fixation. This unique procedure is indicated to the unilateral radiculopathy in young patients. As for posterior approach, a conventional laminectomy is just destructive with delayed kyphosis. In order to reduce this serious complication, laminoplasty has been performed particularly in Japan since the 1980s. There are open-door and double-door laminoplasty in this technique, and the decision is made mainly by surgeons’ preference. Laminoplasty is good for multi-level spondylosis and ossification of the posterior longitudinal ligament (OPLL). The spacer for this approach consists of metal in most cases. Percutaneous endoscopic cervical foraminotomy (PECF) is chosen in cases of unilateral radiculopathy. In this presentation, various surgical techniques to the cervical degenerative disease are shown with advantages and pitfalls and the importance of minimally invasive surgery is stressed, based on my clinical experience.
Posterolateral Endoscopic Thoracic Discectomy: Transforaminal Approach Sang Ho Lee
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Objective: Symptomatic soft herniated thoracic disc (HTD) before the use of magnetic resonance imaging (MRI) was a rare disease with less than 1% of all spinal disc herniation. The frequency of diagnosis of thoracic disk herniation has increased with the routine use of MRI. To avoid high morbidity and complications associated with conventional approach, the authors applied posterolateral endoscopic technique. Methods: From January 2001 to December 2016, 87 patients with non-sequestrated and soft lateral or central thoracic disc herniation underwent posterolateral endoscopic thoracic discectomy (PLETD). Under local anaesthesia with intravenous sedation, we removed the herniated disc through thoracic intervertebral foramen after foraminoplasty. The enlargement of the foramen by partially cutting the lateral aspect of superior facet with a Reamer or high-speed diamond drills. Clinical outcome was measured by the Oswestry Disability Index (ODI) and the visual analogue scale. Results: Fifty-one males and thirty-six females, aged 21 to 89 years were enrolled in this study. Mean follow-up period was 10 months (1 to 56 months). The mean ODI scores improved from 53.7 before surgery to 16.9 at the final follow-up (p < 0.05). Mean VAS scores improved from 7.3 before surgery to 2.1 at the final follow-up (p < 0.05). One patient required conversion to an open procedure for recurred disc protrusion in 17 days. Another one patient required repeated PLETD for recurring disc in l year. Three patients experienced transient low extremity paresthesia but all improved. There were no other serious complications associated with this procedure. Conclusion: Conventional treatment of HTD is known for its high morbidity and complications, posing a challenge to physicians. This PLETD technique for symptomatic non-sequestrated and soft HTD is a safe and effective method that provides a direct route to the lesion under local anaesthesia with less morbidity.
Management of The Cervical Spine Tuberculosis Sabri Ibrahim
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Tuberculosis of the cervical spine is a rare clinical condition (10%), most commonly affected lower thoracic region (40-50% of the cases). Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Characteristically, there is a destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. For the diagnosis of spinal tuberculosis, magnetic resonance imaging is more sensitive than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates an involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Anti-tuberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. With early diagnosis and early treatment, the prognosis is generally good.
Anti-TB Drug for Tuberculosis Spondylitis Chandra Satria Ibrahim
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Tuberculosis spondylitis, or spinal tuberculosis, is a disease that occurs throughout the world. Conservative therapy that is given to patients with spinal tuberculosis actually gives good results, but in certain cases, it requires surgery and rehabilitation therapy. The incidence of tuberculous spondylitis varies worldwide and is usually associated with the quality of available public health service facilities as well as the social factors in the country. Currently, tuberculosis spondylitis is a major source of morbidity and mortality in underdeveloped countries, especially in Asia, where malnutrition and population still remains a major issue. The goals of therapy in tuberculosis spondylitis are eradication of infection or at least to prevent neurological deterioration, and prevention or correction of a deformity or neurological deficit. Administration of anti-tuberculosis drugs is a major therapeutic principle in all cases including spinal tuberculosis. Early administration of anti-tuberculous drugs can significantly reduce morbidity and mortality.
Brachial Plexus Surgery Sevline Estethia Ompusunggu; Rully Hanafi Dahlan
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

The magnitude problems of brachial plexus lesions are not only about the surgical approaches but also the basic problems. Its vague clinical symptoms, the complexity of anatomy structure, the use of advanced imaging followed by electrophysiology to address the lesions, and the challenging of surgical timing and options make those lesions management more challenging. These challenges in Indonesia are more difficult because not so many neurosurgeons are familiar with brachial plexus surgery. Brachial plexus surgery is in evolution. For brachial plexus nerve sheath tumours, a fascicular level resection of tumours and preservation of uninvolved fascicles is now possible. Neuropathic pain may be improved by a dorsal root entry zone lesion procedure. The timing of surgery is different in each pathology, especially in traumatic injury. In traumatic injury, it depends on several factors, e.g. the mechanism of injury, type of injury, the speed of the vehicle, and the mode of fall while victim lands on the ground. The common surgical options in traumatic injury are direct repair by means of an end-to-end suture, external neurolysis, nerve grafting, and nerve transfers. Secondary reconstruction to improve function has been widely introduced such as soft-tissue reconstruction (tendon/muscle transfer or free muscle transfer) and bone procedures (arthrodesis or osteotomy). Brachial plexus surgery demands a broad multidisciplinary approach to a common problem, targeting not only the peripheral nerve, but also the brain, spinal cord, muscle, end-organ, bone and joints, and their complex interactions.

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