spine trauma jember

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    Nugroho Setyowardoyo - NUG

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    Columna vertebralis

    Kolom tulang belakang terdiri dari tulang disebutvertebra

    Vertebra ini terhubung di bagian depan tulang belakang

    dengan diskus intervertebralis

    Kolom tulang belakang terdiri dari:

    vertebra cervikal tujuh (C1-C7) yakni leher

    dua belas vertebra toraks (T1-T12) yaitu punggung atas

    lima vertebra lumbal (L1-L5) yaitu punggung bawahtulang sakrum

    tulang ekor

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    Pada umumnya, vertebra terdiri dari:

    1. Vertebra body di depan2. 2 pedicle yang menghubungkan body

    dengan prossesus spinosus

    3. 2 prosesus tranversusBODY

    PEDICLE

    transverse

    process

    spinous process

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    SYaraf:

    Susunan saraf pada spine terdiri dariakar saraf ( roots) dan saraf tulang

    belakang (spinal cord).

    Spinal cord membentang dari dasar

    otak ke bawah hingga level L1-2.

    Dibawah tingkat L1-L2 ujung sumsumtulang belakang, anyaman dari akar

    saraf berlanjut, yang disebut cauda

    equina.

    Pada setiap tingkat vertebra tulang

    belakang terdapat sepasang akar saraf

    yang disebut roots . Saraf ini

    menginervasi bagian tubuh tertentu

    sesuai levelnya.

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    Denis membagi spine menjadi 3bagian:

    Columna Anterior

    Anterior longitudinal ligamen

    Anterior part of vertebral body

    Anterior portion of annulus fibrosis

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    Denis membagi spine menjadi 3bagian:

    Middle column

    Posterior logitudinal ligament

    Posterior part of vertebral body

    Posterior portion of annulus

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    Denis membagi spine menjadi 3bagian:

    Posterior column

    Bony and ligamentous posterior

    element

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    Berguna untuk:

    Menentukan MOI

    Menilai stabilitas dari spine

    Stabilitas tulang belakang tergantung padasetidaknya dua kolom yang utuh

    Fraktur yang melibatkan hanya kolom anteriordianggap stabil

    Fraktur melibatkan kolom media atau semua tigakolom dianggap tidak stabil

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    Fraktur kompresiHasil dari fleksi anterior atau lateral sehinggaadanya kerusakan kolom anterior

    Radiologi: Tinggi vertebral body bagiananterior berkurangBiasanya stabil dan jarang ada defisitneurologis

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    Fraktur Kompresi

    Thomson, 2002

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    Burst Fraktur

    Kegagalan kedua kolum anterior dan medial

    Aksial loading secara vertikal akan diteruskan ke

    segala arah pada kolum vertebra sehingga timbulletupan dan hancur

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    Burst Fraktur

    MOI yang sering terjadi

    Jatuh Dari Ketinggian

    Galli, 2007

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    Wong DA, 2007

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    Wong DA, 2007

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    Burst Fractures Lateral x-ray : vertebral body height

    AP x-ray : interpedicular distance

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    Flexion-Distraction Injury

    Radiologis

    interspinous process distance on AP view

    posterior height of vertebral body in lateral view

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    Fraktur-Dislocation Deniss subtipe fraktur dislokasi

    Posteroanterior shear-type

    Anteroposterior shear-type

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    Insult to spinal cord resulting in a change,

    in the normal motor, sensory or autonomic

    function. This change is either temporary orpermanent.

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    Runs through the vertebral canal

    Extends from foramen magnum tosecond lumbar vertebra

    Regions Cervical

    Thoracic

    Lumbar

    Sacral

    Coccygeal

    Gives rise to 31 pairs of spinal nerves

    All are mixednerves Not uniform in diameter

    Cervical enlargement: supplies upperlimbs

    Lumbar enlargement: supplies lowerlimbs

    Conus medullaris- tapered inferior end Ends between L1 and L2

    Cauda equina - origin of spinal nervesextending inferiorly from conusmedullaris.

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    Connective tissue membranes Dura mater: outermost layer; continuous

    with epineurium of the spinal nerves

    Arachnoid mater: thin and wispy

    Pia mater: bound tightly to surface Forms the filum terminale

    anchors spinal cord to coccyx

    Forms the denticulate ligaments that attachthe spinal cord to the dura

    Spaces

    Epidural: external to the dura Anesthestics injected here

    Fat-fill

    Subdural space: serous fluid

    Subarachnoid: between pia andarachnoid

    Filled with CSF

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    Anterior median fissure andposterior median sulcus deep clefts partially separating left

    and right halves

    Gray matter: neuron cell bodies,dendrites, axons

    Divided into horns

    Posterior (dorsal) horn

    Anterior (ventral) horn

    Lateral horn

    White matter Myelinated axons

    Divided into three columns(funiculi) Ventral

    Dorsal

    lateral

    Each of these divided intosensory or motor tracts

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    Commissures: connections betweenleft and right halves

    Gray with central canal in thecenter

    White

    Roots

    Spinal nerves arise as rootletsthen combine to form dorsal andventral roots

    Dorsal and ventral roots mergelaterally and form the spinal

    nerve

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    Recall, it is divided into horns Dorsal, lateral (only in thoracic region), and ventral

    Dorsal half sensory roots and ganglia

    Ventral half motor roots

    Based on the type of neurons/cell bodies located ineach horn, it is specialized further into 4 regions Somatic sensory (SS) - axons of somatic sensory neurons

    Visceral sensory (VS) - neurons of visceral sensory neur.

    Visceral motor (VM) - cell bodies of visceral motor neurons

    Somatic motor (SM) - cell bodies of somatic motor neurons

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    Figure 12.31

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    Divided into three funiculi (columns) posterior, lateral,and anterior Columns contain 3 different types of fibers (Ascend., Descend.,

    Trans.)

    Fibers run in three directions Ascending fibers - compose the sensory tracts

    Descending fibers - compose the motor tracts

    Commissural (transverse) fibers - connect opposite sides of cord

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    Pathways decussate (most)

    Most consist of a chain of two or three neurons

    Most exhibit somatotopy (precise spatial

    relationships) All pathways are paired

    one on each side of the spinal cord

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    Descending tracts deliver motorinstructionsfrom the brain to the spinal cord

    Divided into two groups Pyramidal, or corticospinal, tracts

    Indirect pathways, essentially all others Motor pathways involve two neurons

    Upper motor neuron (UMN)

    Lower motor neuron (LMN)

    aka anterior horn motor neuron (also,finalcommon pathway)

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    Includes all motor pathways not part of the pyramidal system

    Upper motor neuron (UMN) originates in nuclei deep in cerebrum(notin cerebral cortex)

    UMN does notpass through the pyramids!

    LMN is an anterior horn motor neuron

    This system includes

    Rubrospinal

    Vestibulospinal

    Reticulospinal

    Tectospinal tracts

    Regulate: Axial muscles that maintain balance and posture

    Muscles controlling coarse movements of the proximal portions of limbs

    Head, neck, and eye movement

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    Note:1. UMN cell body location

    2. UMN axon decussates in pons3. Synapse between UMN and LMN

    occurs in anterior horn of sc3. LMN exits via ventral root4. LMN axon stimulates skeletal

    muscle

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    Reticulospinal tracts originates at reticular formation ofbrain; maintain balance

    Rubrospinal tracts originate in red nucleus of

    midbrain; control flexor muscles

    Tectospinal tracts - originate in superior colliculi andmediate head and eye movements towards visual targets(flash of light)

    Nerve pathways

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    Descending Tracts

    Tract Signal

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