Neurologico Spinale Medico Chirurgico Journal
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DISTRIBUTION AND CHARACTERISTICS OF HEAD INJURY AND REFERRAL NUMBER AT DR H. ANDI ABDURRAHMAN NOOR GENERAL HOSPITAL, TANAH BUMBU, SOUTH BORNEO, INDONESIA
No full textBackground: Head injury (HI) has been one among leading causes of morbidity and mortality worldwide especially in the peripheries area. In South Borneo, 9.4% of trauma cases was a head injury. Especially, Tanah Bumbu Regency, one of peripheries area in South Borneo ranks third for head injuries after Tabalong and Tanah Laut Regency in 2007.Objective: The aim of this study was to describe the characteristics of head injury patient and referral number at Dr. H. Andi Abdurrahman Noor general hospital.Methods: All head injury patients admitted to the emergency department (ED) of Dr. H. Andi Abdurrahman Noor general Hospital in a one-year period (2017) were registered in this retrospective study. Using the total population sampling method, 413 cases of head injury during the period were included as a subject of study.Result: This study showed that mild head injury was the most cases of head injury with 325 cases (78.2%). 61 patients were referred to a higher trauma center in 2017. Head injury was most common in 11-20 years old age group. Men also had higher incident rate compared to women (2:1). Most of the patients were a nonstate employee. Head injury is commonly caused by traffic accident.Conclusion: This study shows that characteristics of HI in the peripheries area such Tanah Bumbu regency are no different from other countries. Our findings suggest that several prevention steps should be taken to reduce the number of head injury based on the distribution and characteristics of head injury sustainers
CERVICAL GUNSHOT INJURY
No full textThe incident of cervical spine injury and cervical spinal cord injury is between 2.0% to 5.0%. The advanced trauma life support (ATLS) stated that a patient with multiple traumas should be assumed tohave cervical spine injury especially if the patient loses consciousness when present in the ER. It is stressed that cervical spine injury requires continuous immobilization of the patient’s entire body using a semirigid collar as well as a backboard with tape and straps before and during transfer to a defnitive care facility. The understanding of the mechanism of injury is the most important as the forces transferred are signifcantly different causing different injuries. A serial case reported by Walter and Adkins found that there was no signifcant difference between the patients that have a bullet removed from the neck and patients that have a bullet left in the cervical cord. In both cases, there was no improvement to the neurologic outcome. Kupcha recommends doing selective wound management and observation of retained intracanal bullet fragments in a patient with complete lesion. Surgical decompression after the injury is not recommended. We report a case of 14 year old boy who was treated at Sanglah Hospital referred froman out-of-island Type C Hospital with a spinal cord injury - American Spinal Injury Association A (SCI ASIA A) caused by a gunshot wound in the cervical. Surgical decompression and bullet removal was performedas well as fusion stabilization. He is then treated in the intensive care unit for 48 hours with a slight improvement in motoric of upper and lower extremities
Saving Good Quality of Sleep for Cervical Herniated Nucleus Pulposus Patients
No full textBackground: Cervical herniated nucleus pulposus compresses the nerve roots with clinical pain manifestation and causes sleeping disturbances. The aim of this study was to determine the difference in the quality of sleep before and after surgery.Method: This is a retrospective cohort study. Patients were asked to complete the Pittsburgh Sleep Quality Index (PSQI) and all data was analyzed with the McNemar Test.Result: The outcome revealed that in 98 patients, 72 (73.4%) patients had increased their quality of sleep after surgery.Conclusion: There was a significant difference in the quality of sleep pre- and post-surgery.
MODIFIED LAMINOPLASTY AFTER EXCISION OF CERVICAL SCHWANNOMA WITH LARGE EXTRAVERTEBRAL EXTENSION
No full textTumour excision and laminoplasty are commonly performed as surgical treatment of extra vertebral extension of cervical schwannoma. It is worth knowing that the conventional technique of multilevel laminectomy may hinder younger patients in the long-term. This article reports a 30-year old man with an intradural-extramedullary tumour which extended from C4 to T1 that underwent modified laminoplasty. This modified technique is preferable in maintaining the anteroposterior diameter of spinal canal as well as reducing the displacement of guttered lamina
Surgical Tactics to Cervical Myelopathy and Radiculopathy
No full textThere 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.
Anti-TB Drug for Tuberculosis Spondylitis
No full textTuberculosis 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.