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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 134 Documents
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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.
Spinal Trauma: a case report Nasrullah Mustamir
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Introduction: The incidences of both car accident and sport accident have been increasing lately in Indonesia. One of the big problems is about the trauma of the spine. Cervical spine trauma is the most dangerous case. Herein we report one case of Odontoid Fracture Type II. Methods: A 24-years-old man had an accident after jumping into a shallow swimming pool. The patient bumped his head into the floor and suffered from tetraparesis. After that, he was getting better step-by-step. Approximately 3 months later, the patient bumped his head again on a branch of a tree and regressed to tetraparesis again. We established odontoid fracture type II diagnosis from plain cervical x-ray. We decided to do a surgery by using pedicle screws at CII, lateral mass at CI, and fusion at CI and CII. Result: After the surgery, the patient’s health improved. Six months after the operation, the patient recovered well. Conclusion: We can do this operation without c-arm, we performed this operation by free-hand and anatomy landmark.
Delayed Treatment of Spinal Cord Injury In Young: A Case Report Joshua Sutikno
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Background: Spinal cord injury (SCI), one of the problems caused by traffic accidents, has a high morbidity in developing country like Indonesia. In Indonesia, the use of motorcycles is increasing every year. The epidemiological data from Fatmawati Hospital of spinal cord injury in 2014 was 104 cases both traumatic and non-traumatic SCI. In this case, a young boy with worsening of SCI, delayed the treatment for about 3 months. Case: A 19 years-old male complained of limbs paralysis for the past two weeks. He felt numbness and tingling in hamstring and calf areas. From past medical history, he had a motorcycle accident 3 months prior. After the accident, he suffered from extreme low back pain, but he could still move his legs. Due to economic restrictions, the patient refused to go to the hospital, and they chose a traditional treatment. For about three months, the pain was decreasing, but he was never pain-free. As the symptoms continued to worsen, the neurosurgeon decided to decompress the spinal cord and performed discectomy. After a week of treatment, the pain disappeared, motor muscle got better, and he could feel again the sensation on the dermatome of S1. Conclusion: Early treatment is recommended to get a better outcome. The surgery is not the only treatment, rehabilitation and orthotics using are important too. Delayed treatment increases morbidity rate.
Cervical Spine Trauma Management Rully Hanafi Dahlan; Sevline Estethia Ompusunggu; Farid Yudoyono
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

The incidence of spine injury following accidents are still very high in developing countries. Many problems occur after the accident including primary intervention on the scene, transportation to the public primary hospital, the referral system, and finally, the management at the central hospital. Cervical spinal cord injuries represent 20-33% of total spinal injuries with the prevalence of the subaxial levels. In patients with a preoperative neurological deficit due to spine trauma, in case of spinal cord compression or instability, surgery is often the treatment of choice to grant a chance of neurological recovery, early mobilization, and faster return to usual daily activities compared to the conservative treatment. In the past, many authors suggested a delayed surgical treatment to reduce postoperative complications rate, but recent studies have shown that an early decompression (< 72 h) may facilitate a postoperative neurological improvement probably due to the prevention of the secondary mechanisms of damage in acute SCI. In the context of the advanced management of spinal injuries, the main points of the focused assessment, the important waypoints of a full classification of the skeletal and spinal cord injury, the principles of early prioritization and decision making, the outline of the surgical strategy including indications, timing, approaches, technique and post-operative care, and the outline principles of rehabilitation. The authors in this paper try to summarize and create a guideline of management, based on experience in a regional centre.
Lateral Mass Screws, Pitfalls, and Practis Abdul Hafid Bajamal
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Abstract

Lateral mass screws represent a unique challenge to practising spine surgeons because this technique is still the most appropriate technique for fixation at the subaxial spine from C3 to C7. There is a wide range of indications for lateral mass screws fixation including acute and chronic instability resulting from tumours, infections, posterior element fractures, posterior ligamentous injuries, post-laminectomy instability, and following multilevel corpectomy and pseudarthrosis after anterior cervical fusion. Lateral mass screws may be inadequate in cases with poor bone quality secondary to fracture, neoplasm, or revision surgery. Pitfalls and practice of this technique will be discussed.
Fear-Avoidance Beliefs in Chronic Cervical Zygapophyseal Joint Pain Relieve With Medial Branch Block Farid Yudoyono
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
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Background: Chronic posterior neck pain is common, affecting 50–75% of people for 1 year or longer. The zygapophyseal joint is reported to be one of most common causative factors. The fearavoidance is a model that describes how individuals develop chronic pain as a result of avoidant behaviour based on fear. Previous studies shown that medial branch block (MBB) and radio frequency neurotomy were effective for intractable pain. Material And Method: Case 1, TMK, Male, 57 yo, left posterior neck pain, VAS neck 7-8, NDI 46 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (60%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Case 2, RDW, Male, 45 yo, left posterior neck pain, VAS neck 8-9, NDI 40 %, no radiating pain, no neurological deficit. FABQPA score showed high fear (63%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Case 3, TAY, Female, 52 yo, bilateral posterior neck pain, VAS neck 8-9, NDI 52 %, no radiating pain, no neurological deficit. FABQ-PA score showed high fear (60%). Physical examination provokes facet joint pain. Neuroimaging revealed facet degeneration on T1WI and T2WI MRI. Results: Our study reveals that C-MBB might ensure pain relief and decrease analgesic need. Physical activity at 1-, 3- and 6-months post-CMBB intervention were 65%, 60% and 68% of patients, respectively, gained > 50% pain relief. Conclusion: Therapeutic MBB may provide an option for chronic high fear-avoidance beliefs pain of zygapophyseal joint.

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