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"ABSTRAKOBJECTIVE: We determined whether the accuracy of thoracaolumbar pedicle screwdirection placement is optimized with a technique using anatomic landmarks forpedicle screw and using S30 as guidance (Technique 1). This technique wascompared with a technique using anatomic landmarks for pedicle screw placementwithout S3D as guidance (Technique 2).METHODS: T7-L1 specimens were harvested from fresh human cadavers. Pediclescrew placement using technique 2 was performed on lelt side. Vertebral rotationand vertebral tilting measurement was determined using S3D. Then pedicle screwplacement using technique 1 was performed on right side. Axial dissections wereperformed on pedicular specimens. Deviation of the screws from the ideal entry pointor trajectory was analyzed to quantitatively compare the two techniques.RESULTS: Axial analysis of the specimens showed that all screw placements werewithin the pedicles. Scatter plot analysis demonstrated that screws placed usingTechnique 2 were more likely to have the combination of entry points andtrajectories medial to the ideal entry point and trajectory.CONCLUSION: All screw placements were grossly within the confines of thepedicles, regardless of technique, as evidenced by axial dissections analysis."

"Instrumentasi posterior mengharuskan dipertahankannya fiksasi stabil sekrup pedikel di tulang belakang untuk mencapai fusi. Hal ini dapat menjadi sulit terutama pada kondisi tertentu, misalnya pada penurunan densitas masa tulang pedikel. Teknik insersi sekrup dengan lintasan kortikal diharapkan menambah antarmuka sekrup dan tulang dengan meningkatkan engagement antara sekrup dengan korteks tulang. Lintasan sekrup dari arah kortikal infero-superior serta kortikal supero-inferior diharapkan memiliki keunggulan kekuatan cabut (pullout strength) dibandingkan dengan lintasan konvensional dalam mengatasi masalah ini. Penelitian ini bertujuan untuk mendapatkan profil biomekanik awal lintasan kortikal dan perbedaan pull out strength lintasan konvensional (Weinstein, 1992), kortikal infero-superior (Santoni, 2009), dan kortikal supero-inferior. Metode: Sampel dari lumbal (L1-L5) babi Yorkshire (n=30) dilakukan pengukuran morfometri dan dibagi secara acak. Sampel dilakukan pengeboran dan sekrup dimasukkan ke dalam tulang dengan tiga lintasan: konvensional, kortikal infero-superior, dan kortikal supero-inferior. Arah lintasan diperiksa kembali dengan sinar-x. Dilakukan penarikan sekrup dengan arah sesuai aksis insersi sekrup dengan kecepatan translasi 5mm/menit. Hasil dicatat dengan satuan Newton (N). Hasil: Didapatkan rata-rata nilai uji tarik pada kelompok konvensional, infero-superior, dan supero-inferior masing-masing 491,72 (187.23) N, 822,16 (295.73) N, dan 644,14 (201.97) N. Lintasan kortikal infero-superior dan kortikal supero-inferior masing-masing mendapatkan nilai 67% dan 30% lebih tinggi dibandingkan dengan lintasan konvensional. Hasil uji ANOVA satu arah dan uji post-hoc Tukey menunjukkan perbedaan signifikan antara lintasan kortikal infero-superior dengan konvensional (p<0.01). Kesimpulan: Lintasan sekrup dalam tulang lumbal dapat memengaruhi nilai pullout sekrup. Keterlibatan tulang kortikal pada lintasan insersi sekrup baru ini bisa meningkatkan nilai pullout sekrup pedikel. Secara statistik pullout strength lintasan kortikal infero-superior dan kortikal supero-inferior tidak ada perbedaan. Studi ini menunjukkan nilai pullout yang lebih tinggi sebesar 30% dari lintasan yang disarankan peneliti dibandingkan dengan lintasan konvensional, walaupun tidak ada perbedaan signifikan secara statistik.

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Introduction: Posterior instrumentation is aimed to achieve spinal fusion which is helped by maintaining a stable pedicle screw insertion within the pedicle. This presents a challenge especially in conditions with low bone quality. Pedicle screw insertion with cortical bone trajectory is designed to add interface between the screw and the bone through engagement between pedicles and the cortex when compared to conventional pedicle screw insertion. Pedicle screw insertion trajectory from cortical infero-superior and the proposed cortical supero-inferior should obtain better pull out performance when compared with conventional pedicle trajectory. We aim to evaluate the pull out strength differences between conventional (Weinstein, 1992) pedicle screw trajectory, cortical infero-superior (Santoni, 2009), and a proposed cortical supero-inferior trajectory. Methods: Samples from Yorkshire porcine lumbar spine (L1-L5) (n=30) were relieved of soft tissue attachments and dried. Morphometric measurements were conducted and the samples were randomly assigned to three groups. The screws were inserted into the vertebrae by drilling with the three trajectories: conventional, cortical infero-superior, and cortical supero-inferior. The trajectory of the screws were examined using x-rays. Pull-out tests were conducted by applying uniaxial traction in line with the screw trajectory with a translational speed of 5mm/minutes. The results of the pull-out are measured in Newton (N). Results: We obtained a mean value of pullout force in conventional trajectory 491,72 (187.2) N, cortical infero-superior 822,16 (295.73) N, and cortical supero-inferior 644,14 (201.97) N. Cortical infero-superior trajectory and cortical supero-inferior trajectory attained 67% and 30% higher pullout mean respectively. Using one-way ANOVA and a post-hoc Tukey test revealed a significant difference between cortical infero-superior and conventional trajectory (p<0.01). Differing pull out strengths between cortical infero-superior and supero-inferior trajectory showed no statistical significance. Our study showed a 30% higher pull-out strength in our proposed trajectory compared with conventional trajectory although not statistically significant. Conclusion: The trajectory of the screws within the lumbar spine seemed to have an impact in pullout strength. Cortical bone engagement using the novel trajectories may increase screw pullout strength of pedicle screws."

"ABSTRAKLatar Berlakang: Cedera medula spinalis (CMS) merupakan suatu kondisi medis yang kompleks dan dapat menyebabkan disabilitas. Pada CMS terjadi gangguan baik sementara maupun menetap pada fungsi motorik, sensorik, atau otonom. Gangguan tersebut mengakibatkan menurunnya kemampuan fungsional seorang penderita CMS. Penelitian ini bertujuan untuk menilai kesahihan dan keandalan SCIM III versi bahasa Indonesia untuk menilai kemampuan fungsional penderita CMS.Metode: SCIM III versi bahasa Inggris diterjemahkan ke dalam bahasa Indonesia melalui metode penerjemahan forward-backward serta dilakukan cognitivedebriefing sehingga didapatkan SCIM III versi bahasa Indonesia. SCIM III versi bahasa Indonesia ini digunakan kepada 30 orang penderita CMS di dua rumah sakit dan satu wisma penderita CMS di Jakarta. Tiga orang rater menilai setiap subjek menggunakan rekaman video. Penilaian ulang dilakukan oleh peneliti satu minggu kemudian. Kesahihan konstruksi dan kriteria dinilai menggunakan koefisien korelasi. Untuk uji keandalan, digunakan intraclass correlation coefficient untuk menilai keandalan inter-rater, paired t-test untuk keandalan test-retest, dan Cronbach?s α untuk internal consistency.Hasil: Didapatkan nilai korelasi lebih dari 0,4 (p<0,05) untuk kesahihan konstruksi dan kriteria. Intraclass correlation coefficient lebih dari 0,8 (p<0,05) untuk keandalan inter-rater, nilai korelasi lebih dari 0,6 (p<0,05) untuk keandalan test-retest dan Cronbach?s α 0,895 untuk keandalan internal consistency.Kesimpulan: SCIM III versi bahasa Indonesia terbukti sahih dan andal untuk menilai kemampuan fungsional penderita CMS.

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ABSTRACTObjective: Spinal cord injury (SCI) is a medically complex condition and can cause disability. Patients with spinal cord injury usually have either temporary or permanent insult to motor, sensory, or autonomic function. The impairments reduce the functional capacity of the patients. The aim of the study was to assess the validity and reliability of Indonesian version of SCIM III to measure the functional capacity of patients with SCI.Methods: English version of SCIM III was translated to Indonesian involving a forward-backward translation and cognitive debriefing to develop Indonesian version of SCIM III. The tool was administered to 30 patients with SCI in two centers and a residential home of SCI in Jakarta. Three raters evaluate each subject by using video record. Writer assessed each subject one week later. Construct and criterion validity was assessed by using correlation coefficient. For reliability, intraclass correlation coefficient was used for inter-rater reliability, paired t-test for test-retest reliability, and Cronbach?s α for internal consistency.Results: There was correlation coefficient above 0,4 (p<0,05) for construct and criterion validity. Intraclass correlation coefficient above 0,8 (p<0,05) for inter-rater reliability, correlation coefficient above 0,6 (p<0,05) for test-retest reliability and Cronbach?s α 0,895 for internal consistency.Conclusion: Indonesia version of SCIM III was proven to be valid and reliable to assess the functional capacity of patients with SCI."

"Spinal Cord Injury (SCI) adalah kerusakan sumsum tulang belakang yang mengakibatkan gangguan neurologis, yang disebabkan oleh cedera tulang belakang taumatik (TSCI) dan cedera tulang belakang non-traumatik (NTSCI). SCI mengakibatkan gangguan fisik jangka panjang, gangguan fungsi tubuh, status psikologis dan sosial ekonomi. SCI secara drastis mempengaruhi independensi dan kualitas kehidupan. Salah satu penyebab utama cedera medulla spinalis secara non-trauma adalah adanya tumor yang dapat menekan medula spinalis. Klasifikasi tumor di medulla spinalis berdasarkan lokasi tumor pasien yakni intradural-intramedullary, intradural-extramedullary dan extradural. Tumor medulla spinaliis secara garis besar terbagi dua jenis yakni Benign Spinal Cord Tumors, dan Malignant Spinal Cord Tumor. Tujuan: Menganalisis praktik residensi keperawatan medikal bedah dengan menerapkan peran sebagai pemberi asuhan keperawatan dan melakukan analisis pemberian asuhan keperawatan pada pasien dengan masalah muskuloskeletal khususnya SCI dengan pendekatan konsep Need Theory Virginia Henderson. Metode: Studi kasus yang dilakukan pada praktik residensi spesialis keperawatan medikal bedah terhadap pasien spinal cord injury dengan pendekatan teori kebutuhan Virginia Henderson. Hasil: Penulis melakukan asuhan keperawatan kepada 17 (dari total 30 kasus resume) pasien dengan SCI yang disebabkan oleh trauma dan non trauma. Proses asuhan keperawatan menurut Henderson berfokus pada pasien dan keluarga. Virginia Henderson memandang pasien sebagai individu yang membutuhkan bantuan dalam pemenuhan kebutuhannya untuk mencapai kebebasan dan keutuhan tubuh serta pikiran.

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SCI is spinal cord damage that results in neurological disorders, caused by traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI). SCI results in long-term physical impairment, impaired bodily function, psychological and socioeconomic status. Due to functional limitations in the sensory and motor systems, involving lower and upper extremity function, SCI drastically affects independence and quality of life. One of the main causes of non-traumatic spinal cord injury is the presence of tumors that can compress the spinal cord in patients (New et al., 2017). The classification of tumors in the spinal cord is based on the location of the patient's tumor, namely intradural-intramedullary, intradural-extramedullary and extradural (Kumar et al., 2020). Spinal cord tumors are broadly divided into two types, namely benign spinal cord tumors and malignant spinal cord tumors.

Objectives: To analyze the practice of medical surgical nursing residency by applying the role as a nursing care provider and to perform a nursing analysis of providing nursing care to patients with musculoskeletal problems, especially SCI with Virginia Henderson's Need Theory concept approach.

Methods: The author's case study was carried out in this medical surgical nursing specialist residency practice for spinal cord injury patients with a virginia Henderson needs theory approach.

Results: The author provided nursing care to 17 (out of a total of 30 cases resumed) patients with SCI caused by trauma and non-trauma. The nursing care process according to Henderson focuses on the patient and family. Virginia Henderson views patients as individuals who need assistance in meeting their needs to achieve freedom and wholeness of body and mind."

"Pasien dengan kasus cedera/trauma spinal memerlukan perawatan yang komprehensif dan mungkin akan membutuhkan waktu yang lama untuk pasien dapat beradaptasi dengan perubahan-perubahan yang terjadi pada dirinya. Selama pasien menjalani masa perawatan di rumah sakit, asuhan keperawatan yang tepat diberikan kepada pasien adalah dengan model konsep teori adaptasi Roy. Asuhan dengan pendekatan model adaptasi ini menjadi pilihan yang sesuai untuk kasus-kasus perawatan jangka panjang sehingga pasien dapat menjalani kehidupan lanjutan pasca perawatan dengan baik, mengembalikan kemandirian, kepercayaan diri terutama konsep gambaran diri dan status peran di masyarakat. Perawat dengan pendidikan spesialis harus mampu menjalankan berbagai peran terutama sebagai Clinical Care Manager, dengan demikian peningkatan layanan keperawatan di rumah sakit dapat dicapai dengan lebih optimal dan memberikan kepuasan pelanggan. Adapun pasien dengan masalah neurologis yang menjalani perawatan jangka panjang, immobilisasi dan disabilitas akan beresiko besar terhadap kejadian thrombosis vena dalam, dengan demikian perlu adanya suatu model asesmen penilaian resiko sehingga pencegahan dan tatalaksana terhadap kondisi tersebut dapat dilakukan lebih dini agar pasien terhindar dari komplikasi perawatan dan meningkatkan keselamatan pasien selama perawatan di rumah sakit. Laporan analisis praktek ini membahas mengenai asuhan keperawatan pada pasien dengan cedera spinal dengan menggunakan pendekatan model konsep adaptasi Roy, resume 30 kasus pasien dengan gangguan neurologis di RSCM dan RS PON Jakarta, laporan praktik keperawatan berbasis fakta yaitu model asesmen resiko kejadian thrombosis vena dalam dan inovasi keperawatan. Diharapkan laporan karya ilmiah akhir ini dapat menjadi salah satu informasi untuk pengembangan pendidikan keperawatan spesialis terutama perawat yang memberikan layanan kepada pasien dengan gangguan neurologis.

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Patients with spinal injuries or neurological disorders require comprehensive care and it may take a long time for the patient to adapt with the changes. During the patient's stay in the hospital, appropriate nursing care should be given to the patient, using the Roy adaptation theory concept model. This model is one of the best appropriate nursing care approach for long-term care cases so that patients can lead a good post-treatment life, restore independence, self-confidence, especially the concept of self-image and role status in society. Nurses with specialist education must be able to carry out various roles, especially as a Clinical Care Managers, thus improving nursing services in hospitals can be achieved more optimally and provide customer satisfaction. As for patients with neurological problems who undergo long-term care, immobilization and disabilities will be at great risk for the incidence of deep vein thrombosis, thus it is necessary to have a risk assessment model so that prevention and management of these conditions can be carried out earlier to avoid complications of treatment and improve patient safety during hospitalization. This practice analysis report discusses nursing care in patients with spinal injuries using Roy's adaptation concept model approach, resumes of 30 cases of patients with neurological disorders at RSCM and PON Jakarta Hospital, reports on fact- based nursing practice, namely a model of risk assessment for deep vein thrombosis and innovation. nursing. It is hoped that this final scientific paper report can be one of the information for the development of specialist nursing education, especially nurses who provide services in neuro care unit."

"ABSTRAKCedera Medula Spinalis (CMS) merupakan kerusakan pada medula spinalis danakar syarafnya yang mengakibatkan defisit neurologis akibat trauma atau nontrauma. Seksualitas merupakan bagian integral dari kehidupan seseorang terutama masalah kompleks yang muncul setelah cedera medulla spinalis namun masalah seksual masih dianggap tabu (taboo) untuk didiskusikan dan dipublikasikan terutama di Indonesia. Penelitian ini bertujuan untuk mendapatkan gambaran makna dari pengalaman perubahan fungsi seksual pada klien dengan cedera medulla spinalis. Desain penelitian adalah pendekatan fenomenologi pada enam partisipan. Pengumpulan data dengan wawancara mendalam dan catatan lapangan. Analisa data menggunakan metode Collaizi. Penelitian ini menghasilkan enam buah tema yaitu 1) kesedihan akibat kelemahan/perubahan fisik, 2) adanya perubahan fungsi seksual, 3) respon psikologis terhadap perubahan fungsi seksual, 4) cara mengekspresikan fungsi seksual, 5) harapan untuk memenuhi kebutuhan seksual dan 6) harapan terhadap pelayanan keperawatan di rumah sakit dalammengatasi masalah kebutuhan seksual

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ABSTRACTSpinal cord injury (SCI) is a damage of the spinal cord and nerve roots that lead to neurological deficits due to trauma or non-traumatic. Sexuality is an integral part of a person's life, especially the complex problems that arise after a spinal cord injury but sexual matters are considered taboo (taboo) to be discussed and publicized, especially in Indonesia. The purpose of this study was to get an idea of the significance of experience changes in sexual function in clients with spinal cord injury. This is a qualitative study with phenomenological approach involving six participants. Collecting data with in-depth interviews and field notes. Data were analyzed with Collaizi's method. The result found six themes,1) sadness due to weakness / physical changes, 2) change in sexual function, 3) the psychological response to changes in sexual function, 4) how to express sexual function, 5) hopes for the sexual needs and 6) expectations of nursing care in hospitals addressing sexual needs"

"Spinal Cord Injury (SCI) merupakan suatu gangguan muskusloskeletal yang berdampak besar baik dari segi fisik, sosial dan ekonomi. SCI berdampak kelemahan pada ekstremitas, tingkat keparahan kelemahan bergantung pada area spinal cord yang terganggu. Untuk itu perlu perawatan yang lama dalam pemulihan dan adaptasi terhadap kelemahan terkait aktivitas sehari hari pasien. Laporan ini merupakan hasil analisa kegiatan praktek residensi penerapan Evidence Based Nursing (EBN) dengan pendekatan Model Adaptasi Roy dalam peran care provider, peneliti, innovator dan role model. Hasil dari penerapan model Adaptasi Roy dapat diaplikasikan pada pasien dengan gangguan muskuloskeletal dimana pasien membutuhkan kemampuan adaptasi dalam menjalani perawatan. Hasil penerapan EBN menunjukkan bahwa relaksasi mendengarkan musik dan masase punggung dapat mengurangi nyeri dan kecemasan. Hasil dari kegiatan inovasi adalah panduan format komunikasi SBAAR (Situation, Background, Assesment and Recommendation)

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Spinal Cord Injury (SCI) is one of musculosceletal disorder that distrub physic, social and economic faktors. Effect of SCI are extremities weakness, para parese depand on injury areas of spinal cord. Furtermore patients needs adaptation in his/hers paraparese to doing actuvuty daily living (ADL). This article shows tat clinical practice of recidency using Adaptation Roy Model as provider care, researcher, innovator and role model. Result of Adaptation Roy Modelapproach shows that effective in musculosceletal disorder patient care, who nees ability to asaptation in ADL. Result of Evidence Based Nursing shows that relaxation music therapy and back massage effective to reduce pain and anxiety. Result of innovation project format of SBAR (Situation, Background, Assesment and Recommendation)."

"Cedera servikal merupakan salah satu cedera tulang belakang terbanyak pada pasien trauma. Di Amerika Serikat tahun2008 dari 100.000 kasus cedera tulang belakang, sebanyak 67% merupakan kasus cedera servikal. Penilaian awaldilakukan berdasarkan American Spinal Cord Injury Association (ASIA) impairment score namun prognosis outcomesering tidak diperhatikan. Tujuan penelitian untuk menganalisis nilai functional independence measure (FIM) pasiencedera servikal dengan manajemen konservatif dan korelasi dengan umur, jenis kelamin, jenis trauma, onset trauma,abnormalitas servikal, jenis lesi cervical spine, dan ASIA impairment score. Dilakukan studi kohor prospektif padasemua pasien cedera servikal yang memenuhi kriteria inklusi di bagian Bedah Saraf Rumah Sakit (RS) Dr. HasanSadikin Bandung. Subjek dikelompokkan berdasarkan umur, jenis kelamin, trauma tunggal/multipel, akut/kronik,abnormalitas servikal, lesi komplit/inkomplit dan ASIA impairment score. Pemeriksaan nilai FIM dilakukan diPoliklinik Bedah Saraf. Data dianalisis menggunakan uji t dan uji chi-kuadrat. Terdapat 17 pasien cedera servikal yangdirawat di bagian Bedah Saraf RS Dr. Hasan Sadikin Bandung periode April 2009?April 2010. Observasi kohorprospektif rata-rata nilai FIM pasien cedera servikal adalah 4±1,63. Analisis chi-kuadrat menyebutkan bahwa tidakterdapat hubungan umur, jenis kelamin, jenis trauma, onset trauma, abnormalitas servikal dengan besarnya nilai FIMpasien cedera servikal. Terdapat hubungan jenis lesi cervical spine, ASIA impairment score dengan besarnya nilai FIMpasien cedera servikal. Jenis lesi cervical spine dan ASIA impairment score memiliki hubungan bermakna denganbesarnya nilai FIM pasien 6 bulan pascacedera servikal.

Cervical spine injury is one of the most common spinal cord injuries in trauma patients. From 100,000

spinal cord injury cases reported in the United States of America (2008), sixty seven percent involve cervical spine

injury. American Spinal Cord Injury Association (ASIA) impairment score is used as an initial assessment but not

enough attention prognostic outcome of these patients was paid to. The objective of this study is to analyze the value of

functional independence measure (FIM) cervical spine injury patients with conservative management and its correlation

with age, sex, type of trauma, onset of trauma, cervical abnormalities, type of cervical spine lesion and ASIA

impairment score. A prospective cohort study was performed to all patients with cervical spine injury treated in

Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung that fullfiled the inclusion criteria. The subjects were

classified based on age, sex, single/multiple trauma, acute/chronic, cervical abnormalities, complete/incomplete lesion

and ASIA impairment score. The FIM examination was performed in Outpatient clinic of Neurosurgery. T-test and chisquare

test was done to analyze the data. There were 17 cervical spine injury patients treated in Neurosurgery

Department of Dr. Hasan Sadikin Hospital during April 2009?April 2010. The average FIM value of cervical spine

injury in those patients is 4+1.63 by cohort prospective study. There were no correlation between FIM value with age,

sex, type of trauma, onset of trauma and cervical abnormalities. Significant correlations were found between FIM value

with type of cervical spine lesion and ASIA impairment score in cervical spine patients. Type of cervical spine lesion

and ASIA impairment score have significant correlation with FIM value of patients in 6 months after cervical injury."