neck pain surgery
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TATA LAKSANAOPERATIF PADA PASIEN
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Nyeri Definition : Pain is an unpleasant
feeling that is conveyed to thebrain by sensory neurons.
Neck pain / cervical pain : is thesensation of discomfort in theneck area. Neck pain can resultfrom disorders of any of thestructures in the neck, includingthe cervical vertebrae andintervertebral discs, nerves,
muscles, blood vessels,esophagus, larynx, trachea,lymphatic organs, thyroid gland,or parathyroid glands.
medical-dictionary.thefreedictionary.com/cervical
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SpinothalamicTract
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Epidemiologi
Difficult to determine In Norway, (Bovim and colleagues) found a
prevalence of 13.8%.
In Finland, (Makela) discovered neck pain in 9.5% of
males and 13.5% of females. The United States' National Center for Health
Statistics reported 7.0% of men and 9.4% of womenhad neck pain in the period between 1976-1980.
Older patients, those involved in both mentally andphysically stressful jobs, and current smokers weremore likely to have neck pain.
More common in women
http://www.digital-doc.com/neckpain.htm
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Penyebab nyeri leher
Non-bedah
bedah
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Evaluasi klinis
Anamnesis, pemeriksaan fisikneurologis, penunjang
Defisit neurologis operasi Nyeri tanpa defisit neurologis terapi
konservatif 6 minggu
Riwayat demam, keringat malam, beratbadan turun, keganasan, infeksiearly diagnosis
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Defisit neurologis
Mielopati; defisit yang jelas,
mengganggu keseharian, cenderungmemburuk
Nyeri yang membaik dengan terapi
konservatif defisit neurologis jarangmembaik dengan penundaan / tanpapembedahan
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Tata laksana bedah
Anterior vs posterior
Anterior : melintasi struktur penting
(karotis, trakea, esofagus) Excellent exposure
Fusi
Dapat digunakan ada berbagai keadaan Minimal blood loss
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Tata laksana bedah
Anterior vs posterior
Posterior : disc is not as visible,
exposure not easy, Provide central / foraminal
decompression without fusion
foraminotomy, laminectomy, orlaminoplasty
Contraindication : loss of sagital
lordosis
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Radikulopati
Tujuan : Dekompresi radiks saraf
Anterior : lebih disukai, terutama bila
melibatkan 3 level, bilateral, perubahanlordosis servikal, nyeri leher kronik danberat
Posterior : unilateral, lebih dari 3 level,foraminotomi C7-T1 (sulit dicapai lewatanterior), obese, leher pendek, riwayatkegagalan ACDF
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Anterior ACDF Diseksi M. platysma
Membuka celah antara msternokleidomastoideus dan trakea-esofagus
Pelihara karotid sheath (a. carotis, v.jugular, n. laryngeus rekurens)
Exposure vertebra dan diskus
Eksisi diskus, osteofit
Bone graft
melebarkan foramen
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Posterior posteriorforaminotomi
Splitting m. paraspinal
Diseksi muskulus yang melekat pada
spina ekspose massa lateral dansendi faset
Burr untuk menipiskan daerah
foramen, tulang diangkat Fusi jarang diperlukan
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Outcome
ACDF untuk radikulopati 905success rate, most common procedure
3 level ACDF gangguan stabilitas Posterior foraminotomi : efektif, tidak
perlu fusi, less reliable
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Nyeri leher aksial
Fusimenghilangkan pergeseranantar segmen saat bergerak
Mengurangi nyeri akibat degeneratif Nyeri kronik tidak membaik dengan
terapi konservatif
ACDF vs posterior fusion
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Posterior cervical fusion
Ekspose massa lateral
Kapsul faset dilepaskan, sendi faset
dibuka, tulang rawan diangkat Bone graft pada sendi untuk fusi
Lateral mass screw
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Outcome
Suboptimal
Luaran klinis memburuk dengan makin
banyak leel yang dilakukan fusi Nyeri pasca operasi tersisa
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Myelopati
Dekompresi medulla spinalis(multiprosedural)
Protruding disk ACDF OPLL
Anterior: pengangkatan osteofit, PLL,
korpektomi Posterior : laminektomi +/- fusi,
laminoplasti
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Anterior vs posterior
Anterior Posterior
< 3 level > 3 level, lordosis
baik> 3 level, kifosis
Improvement85%
99%
66%laminektomi ;92% laminoplasti
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References
1. Ahn NU, Ahn UM, andersson GBJ, An HS. Operatie treatment of the patient with neckpain. Phys Med Rehabil Clin N Am 14 (2003) 675-92
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