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"ABSTRAK Pendahuluan. Osteoarthritis (OA) adalah sebuah penyakit sendi degeneratif yangmenyebabkan disabilitas dengan prevalensi yang terus meningkat. Hormonpertumbuhan memiliki efek regenerasi tulang rawan secara langsung melaluistimulasi sel kondroblas dan proses morphoangiogenesis juga melalui faktorpertumbuhan secara sistemik. Penelitian ini bertujuan untuk mengetahui manfaatsuntikan sendi dengan hormon pertumbuhan pada kasus Osteoarthritis. Metode Penelitian. Penelitian dilakukan di Rumah Sakit Hewan InstitutPertanian Bogor pada bulan Mei hingga September 2015. Desain penelitian adalahrandomized post test only control group. Sejumlah 21 ekor kelinci Selandia Baruputih, berat 1.9-2.6kg, usia 7-8 bulan. Kelinci dibagi secara acak menjadikelompok kontrol (NaCl 0.9%), suntikan hormon pertumbuhan (4iu), dan suntikanasam hyaluronat (6mg) . Dengan metode acak tersamar dilakukan suntikankolagenase tipe II C. Histolyticum pada hari 1 dan ke 4 pada lutut kiri, kemudiantindakan penyuntikan dilakukan sebanyak tiga kali dengan selang waktu 1minggu. Evaluasi dengan periode kepincangan, skoring makroskopis, histologisdilakukan pada minggu ke-8 pasca penyuntikan pertama. Temuan Penelitian. Berdasarkan hasil penelitian ditemukan periode kepincanganpada grup yang diberikan hormon pertumbuhan lebih singkat, dan bermaknasecara statistik dibandingkan dengan grup kontrol (p<0.001), grup asamhyaluronat (p<0.03), dan grup hormon pertumbuhan (p<0.001). Evaluasi skormakroskopik dengan skor yoshimi menunjukan bahwa kelompok hormonpertumbuhan memiliki kerusakan tulang rawan yang lebih ringan jikadibandingkan dengan grup kontrol (p=0.001) dan grup asam hyaluronat (p=0.04).Skoring histopatologis menggunakan skor modifikasi Mankin menunjukan padakelompok dengan hormon pertumbuhan memiliki angka terendah dibandingkangrup lainnya (p=0.001), grup kontrol (p=0.001), grup asam hyaluronat (p=0.015). Kesimpulan. Suntikan hormon pertumbuhan ke dalam sendi memiliki efektifitasyang lebih baik dibandingkan dengan Asam hyaluronat pada model osteoarthritis.Hormon pertumbuhan memberikan harapan baru sebagai alternatif dalam terapiosteoarthritis.ABSTRACT Introduction. Osteoarthritis is a degenerative joint disorder that cause disabilityfor patients all over the globe, with an increasing number of patients. Growthhormone (GH) works trough direct and indirect effect on cartilage regeneration bychondroblast stimulation, stimulation of growth factors and morphoangiogenesisprocess. Further research is needed to know the effects of intra articular jointinjection of growth hormone using validated animal model and reliable outcomemeasurement. Methods. This study was conducted in Animal Hospital of Agricultural InstituteBogor west Java, from May to September 2015. The design of the study wasrandomized posttest only control group. Male white New Zealand rabbit (n=21)weighted 1.9-2.6kg, age 6-7months were used in this study. The sample wasrandomized and divided into three groups. All groups recieved intra articularinjection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1and 4. Injections of growth hormone (4iu), hyaluronic acid (HA) (6mg) and saline(0.6ml) were done at 2 weeks after collagenase injection once a week forconsecutive 3 weeks. Evaluation of weight and lameness periode is doneperiodically, histopathological and macroscopic score were done at 8 weeks sincethe first injection. Result. The lameness priode for control group is significantly longer than both ofthe experimental groups (p<0.001), HA (p<0.03), and GH (p<0.001).Macroscopic score evaluation taken from the lateral condyle of the left femur showed that the GH group received significantly less cartilage damage than theHA group (P=0.04) and placebo (P=0.01). Histopathological score was also foundlowest at the GH group (p=0.001), with significant difference in control(p=0.001), and HA group (p=0.015).).Conclusion. Intraarticular injection of growth hormone is found to be moreeffective compared to hyaluronic acid on rabbit osteoarthritis model. This resultsshowed promising result for intra articular injection of GH as an alternativetreatment for osteoarthritis.;Introduction. Osteoarthritis is a degenerative joint disorder that cause disabilityfor patients all over the globe, with an increasing number of patients. Growthhormone (GH) works trough direct and indirect effect on cartilage regeneration bychondroblast stimulation, stimulation of growth factors and morphoangiogenesisprocess. Further research is needed to know the effects of intra articular jointinjection of growth hormone using validated animal model and reliable outcomemeasurement. Methods. This study was conducted in Animal Hospital of Agricultural InstituteBogor west Java, from May to September 2015. The design of the study wasrandomized posttest only control group. Male white New Zealand rabbit (n=21)weighted 1.9-2.6kg, age 6-7months were used in this study. The sample wasrandomized and divided into three groups. All groups recieved intra articularinjection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1and 4. Injections of growth hormone (4iu), hyaluronic acid (HA) (6mg) and saline(0.6ml) were done at 2 weeks after collagenase injection once a week forconsecutive 3 weeks. Evaluation of weight and lameness periode is doneperiodically, histopathological and macroscopic score were done at 8 weeks sincethe first injection. Result. The lameness priode for control group is significantly longer than both ofthe experimental groups (p<0.001), HA (p<0.03), and GH (p<0.001).Macroscopic score evaluation taken from the lateral condyle of the left femur showed that the GH group received significantly less cartilage damage than theHA group (P=0.04) and placebo (P=0.01). Histopathological score was also foundlowest at the GH group (p=0.001), with significant difference in control(p=0.001), and HA group (p=0.015).).Conclusion. Intraarticular injection of growth hormone is found to be moreeffective compared to hyaluronic acid on rabbit osteoarthritis model. This resultsshowed promising result for intra articular injection of GH as an alternativetreatment for osteoarthritis.;Introduction. Osteoarthritis is a degenerative joint disorder that cause disabilityfor patients all over the globe, with an increasing number of patients. Growthhormone (GH) works trough direct and indirect effect on cartilage regeneration bychondroblast stimulation, stimulation of growth factors and morphoangiogenesisprocess. Further research is needed to know the effects of intra articular jointinjection of growth hormone using validated animal model and reliable outcomemeasurement. Methods. This study was conducted in Animal Hospital of Agricultural InstituteBogor west Java, from May to September 2015. The design of the study wasrandomized posttest only control group. Male white New Zealand rabbit (n=21)weighted 1.9-2.6kg, age 6-7months were used in this study. The sample wasrandomized and divided into three groups. All groups recieved intra articularinjection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1and 4. Injections of growth hormone (4iu), hyaluronic acid (HA) (6mg) and saline(0.6ml) were done at 2 weeks after collagenase injection once a week forconsecutive 3 weeks. Evaluation of weight and lameness periode is doneperiodically, histopathological and macroscopic score were done at 8 weeks sincethe first injection. Result. The lameness priode for control group is significantly longer than both ofthe experimental groups (p<0.001), HA (p<0.03), and GH (p<0.001).Macroscopic score evaluation taken from the lateral condyle of the left femur showed that the GH group received significantly less cartilage damage than theHA group (P=0.04) and placebo (P=0.01). Histopathological score was also foundlowest at the GH group (p=0.001), with significant difference in control(p=0.001), and HA group (p=0.015).).Conclusion. Intraarticular injection of growth hormone is found to be moreeffective compared to hyaluronic acid on rabbit osteoarthritis model. This resultsshowed promising result for intra articular injection of GH as an alternativetreatment for osteoarthritis."

"ABSTRAK Pendahuluan. Parameter spinopelvik merupakan parameter untuk mengukurkeseimbangan poros tulang belakang terhadap ekstrimitas bawah pada penampangsagital. Parameter ini terdiri dari sagittal vertical axis (SVA), pelvic incidence(PI), pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spinelateral view dalam keadaan berdiri. Pengukuran parameter ini penting sebagaidasar analisa keseimbangan sagital dalam operasi rekonstruktif tulang belakang,karena dengan tidak adanya keseimbangan pada penampang sagital ini akanberakibat timbulnya adjacent segment degeneration yang akan memengaruhiluaran klinis. Hingga saat ini belum ada studi yang mengevaluasi hubungan antaraluaran parameter spinopelvik dengan luaran klinis di indonesia.Metode Penelitian. Penelitian ini adalah penelitian analitik potong lintang dengansubyek 19 pasien dewasa pasca operasi stabilisasi dan fusi tulang belakang torakaldan lumbal di Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta pada tahun2012-2014. Pasien tersebut dilakukan evaluasi X-ray parameter spinopelvik SVA,PI, PT, dan SS dilakukan penilaian skor Indeks Disabilitas Oswestry (IDO) padasaat 1 tahun pasca operasi. Lalu dilakukan analisis statistik dengan menggunakanuji hipotesis komparatif numerik dengan menggunakan pearson dimanadibandingkan luaran parameter spinopelvik SVA, PI, PT, dan SS dengan luaranfungsional skor IDO.Temuan dan Diskusi Penelitian. Didapatkan hasil korelasi antara IDO dan SVA (p<0,001) (r=0,866). Korelasi antara IDO dan PI (p=0,006) (r=0,603). Korelasiantara IDO dan PT (p=0,107) (r=0,382). Korelasi IDO dan SS (p=0,051)(r=0,454).Simpulan. Didapatkan korelasi kuat antara IDO dan SVA serta IDO dan PI.Tidak didapatkan korelasi antara IDO dan PT serta IDO dan SS. SVA dan PImerupakan parameter spinopelvik yang berpengaruh pada luaran pasca operasi fusi tulang belakang torakal dan lumbal. ABSTRACT Introduction. Spinopelvic parameter is a parameter that used to measure thesagital balance of vertebrae in congruency with lower extrimity in sagital plane.This parametr is consist of sagittal vertical axis (SVA), pelvic incidence (PI),pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateralview in standing position. Measurement of this parameter is important as basicanalysis for achieve sagital balance in reconstructive operation of the vertebrae,because if the sagital balance is interupted will cause the adjacent segmentdegeneration that will influence the clinical outcomes. Up until now, there is nostudy that evaluate the spinopelvic parameter with the clinical outcomes inIndonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patientthat had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr.Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwentx-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluationof Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then thestatistical work was done with numeric comparative pearson test analysis todetermine whether there is correlation between SVA, PI, PT, and SS with IDOscore.Result and Discussion. There is strong correlation between IDO and SVA(p<0,001) (r=0,866). Strong correlation between IDO and PI (p=0,006) (r=0,603).No correlation between IDO and PT (p=0,107) (r=0,382). No correlation betweenIDO and SS (p=0,051) (r=0,454).Conclusion. Strong correlation is indicated in IDO and SVA, also in IDO and PI.There is no correlation between IDO and PT, also in IDO and SS. SVA and PI arethe important spinopelvic parameter that have influence on clinical outcome inpost thoracal and lumbar fusion and stabilization patient. ;Introduction. Spinopelvic parameter is a parameter that used to measure thesagital balance of vertebrae in congruency with lower extrimity in sagital plane.This parametr is consist of sagittal vertical axis (SVA), pelvic incidence (PI),pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateralview in standing position. Measurement of this parameter is important as basicanalysis for achieve sagital balance in reconstructive operation of the vertebrae,because if the sagital balance is interupted will cause the adjacent segmentdegeneration that will influence the clinical outcomes. Up until now, there is nostudy that evaluate the spinopelvic parameter with the clinical outcomes inIndonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patientthat had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr.Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwentx-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluationof Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then thestatistical work was done with numeric comparative pearson test analysis todetermine whether there is correlation between SVA, PI, PT, and SS with IDOscore.Result and Discussion. There is strong correlation between IDO and SVA(p<0,001) (r=0,866). Strong correlation between IDO and PI (p=0,006) (r=0,603).No correlation between IDO and PT (p=0,107) (r=0,382). No correlation betweenIDO and SS (p=0,051) (r=0,454).Conclusion. Strong correlation is indicated in IDO and SVA, also in IDO and PI.There is no correlation between IDO and PT, also in IDO and SS. SVA and PI arethe important spinopelvic parameter that have influence on clinical outcome inpost thoracal and lumbar fusion and stabilization patient. "

"Lumbar canal stenosis merupakan penyebab utama disabilitas pasien. Selective Nerve Root Block (SNRB) pada area lumbar adalah salah satu metode terapi untuk mengatasi nyeri akibat radikulopati lumbar yang bertujuan mengurangi kebutuhan operasi. Ultrasonografi (USG) muncul sebagai alternatif dengan kelebihan seperti tanpa radiasi, mobilitas tinggi, kemampuan pencitraan jaringan lunak, dan penetrasi jarum real-time jika dibandinagkan menggunakan Floroskopi. Penelitian ini merupakan studi uji klinis acak non-inferiority tersamar tunggal yang dilakukan di 2 Rumah Sakit. 52 subjek penelitian yang terdiri dari 26 subjek yang dilakukan tindakan SNRB dengan panduan fluoroskopi dan 26 subjek yang dilakukan tindakan SNRB dengan panduan USG. Tidak ada perbedaan karakteristik dasar antara kedua kelompok berdasarkan usia, jenis kelamin, IMT, durasi gejala. level lumbar VAS, maupun ODI pre operasi (p > 0,05). Penelitian ini menunjukkan penurunan signifikan pada nilai VAS di kelompok floroskopi dan USG pada 30 menit, 2 minggu, dan 12 minggu setelah tindakan dibandingkan dengan baseline (p < 0,01). Kendati demikian, tidak ada perbedaan VAS dan ODI yang signifikan antara kedua metode panduan pada setiap titik waktu (p > 0,05). Tidak terdapat perbedaan dalam pengurangan nyeri radikular lumbal, skor ODI, dan kejadian komplikasi antara tindakan SNRB dengan panduan fluoroskopi maupun USG. Penggunaan panduan USG pada SNRB terbukti lebih efisien dengan durasi yang lebih singkat dan sama efektifnya dengan fluoroskopi.

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Lumbar canal stenosis is a leading cause of patient disability. Selective Nerve Root Block (SNRB) in the lumbar area is a therapeutic method aimed at alleviating pain from lumbar radiculopathy to reduce disability and surgical needs. SNRB typically employs fluoroscopy but has drawbacks such as radiation exposure. Ultrasonography (USG) has emerged as an alternative offering benefits. This was a randomized single-blind non-inferiority clinical trial conducted at 2 Hospitals. There were 52 subjects, with 26 undergoing SNRB with fluoroscopy guidance and 26 with USG guidance. No baseline characteristic differences were found between the groups in terms of age, gender, BMI, symptom duration, preoperative lumbar level VAS, or ODI (p > 0.05). The study demonstrated significant reductions in VAS scores in both fluoroscopy and USG groups at 30 minutes, 2 weeks, and 12 weeks post-procedure compared to baseline (p < 0.01). However, no significant differences in VAS and ODI were observed between the two guidance methods at any time point (p > 0.05). There was no difference in the reduction of lumbar radicular pain, ODI scores, and complication rates between SNRB procedures guided by fluoroscopy and USG. USG guidance in SNRB proves to be more efficient with shorter duration and equally effective as fluoroscopy."

"Pendahuluan: Osteoartritis adalah penyakit sendi yang utamanya ditandai defek rawan sendi dan merupakan penyebab utama disabilitas muskuloskeletal. Modalitas terapi injeksi intraartikular dengan hormon pertumbuhan terus dikembangkan guna mengurangi morbiditas. Ditemukan adanya pengaruh injeksi hormon pertumbuhan intraartikular terhadap regenerasi tulang rawan sendi, namun belum ada standar dosis dalam pemberian injeksi. Penelitian ini memfokuskan pada efek pengulangan dosis mingguan terhadap perbaikan rawan sendi model hewan coba.Bahan dan Metode: Penelitian eksperimental ini menggunakan desain post test only control group. Kelinci Selandia Baru jantan sebanyak 24 ekor dibagi secara acak menjadi grup kontrol dan 3 grup perlakuan. Semua subjek diinduksi OA dengan menyuntikkan kolagenase intraartikular. Subjek pada grup kontrol diinjeksi dengan cairan fisiologis, grup GH1 diinjeksi dengan hormon pertumbuhan sebanyak 1 kali, grup GH3 sebanyak 3 kali/3 minggu, dan grup GH5 5 kali/5 minggu. Kelinci diobservasi dan dipantau berat badannya, lalu dilakukan evaluasi histopatologi makroskopik dan mikroskopik.Hasil: Analisis skor makroskopik Yoshimi pada grup GH5 dibandingkan dengan grup GH1 dan kontrol menunjukkan perbedaan yang bermakna secara statistik p=0,002 . Analisis skor mikroskopik Mankin didapatkan tulang rawan pada grup GH1, GH3, dan GH5 dibandingkan kontrol mengalami perbaikan pasca perlakuan yang bermakna secara statistik dan kerusakan yang terjadi minimal p < 0,001.Kesimpulan: Injeksi intraartikular hormon pertumbuhan dosis mingguan selama lima minggu memberikan hasil yang lebih baik secara makroskopis dan mikroskopis terhadap degenerasi tulang rawan pada hewan coba model osteoartritis yang diinduksi dengan injeksi intraartikular kolagenase tipe 2 dibandingkan dengan dosis mingguan selama tiga minggu, dosis tunggal, maupun plasebo.

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Introduction Osteoarthritis, a disease of the joint mainly characterized by a defect on the cartilage and subchondral bone, is one of the main musculoskeletal cause for disability. Intraarticular injection of growth hormone are known as the latest choice in therapy modality. There is some unclear evidence regarding effect of growth hormone injection on cartilage regeneration in osteoarthritis, yet further research is needed. This study focused on cartilage regeneration effect on different weekly dose of intraarticular growth hormone injection.Method This experimental study used a randomized post test only control group design. Twenty four male white New Zealand rabbit were randomly divided into 4 groups control, GH1, GH3, and GH5 . All subjects were injected with intraarticular collagenase. Post induction, control group were injected with normal saline. Intervention groups were all injected with human growth hormone in different cycle, one dose in GH1, 3 times 3 weeks in GH3, and 5 times 5 weeks in GH5. All animal were observed, weight checked regularly, and evaluated for histopathological examination.Result Yoshimi score in GH5 group was significantly lower than control and GH1 group p 0,002 . Those results were confirmed with Mankin score showing statistically significant less damaged and more repaired cartilage tissue on GH1, GH3, and GH5 group compared to control p"

"Latar belakang: Low back pain (LBP) dengan atau tanpa kelainan radikulopati merupakan penyebab utama disabilitas tertinggi ke 6 di dunia. LBP dapat disebabkan oleh stenosis foramen intervertebralis (SFI) lumbal yang disebabkan oleh proses degenerasi vertebra lumbal. Penilaian derajat SFI lumbal saat ini masih menggunakan potongan sagital, namun belum terdapat penilaian derajat SFI lumbal menggunakan potongan aksial Metode: Penelitian observasional analitik potong lintang menggunakan data sekunder; Sebanyak 54 pasien memenuhi kriteria penelitian yang telah dilakukan pemeriksaan MRI lumbal selama Januari 2023 hingga Desember 2023. Analisis kesesuaian antar 2 variabel kategorik disajikan dalam plot Kappa Cohen (R). Hasil: Kesesuaian pengukuran berdasarkan potongan axial dengan potongan sagital mempunyai nilai R sebesar 0,801; p <0,001) menunjukan kesesuaian diagnostik yang hampir sempurna dalam menilai SFI lumbal antara potongan aksial dengan sagital dan hasil uji nonparametrik menggunakan McNemar menunjukan tidak terdapat perbedaan kemampuan diagnosis derajat SFI lumbal mengunakan potongan aksial maupun sagital dengan nilai p 0,209 (p = < 0,5). Kesimpulan: Terdapat kesesuaian yang sangat baik antara potongan aksial dengan potongan sagital dalam menilai derajat SFI lumbal L4-5.

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Background: Low back pain (LBP) with or without radiculopathy is the 6th leading cause of disability in the world. LBP can be caused by lumbar intervertebral foramen stenosis caused by the process of lumbar vertebral degeneration. Current assessment of lumbar intervertebral foramen stenosis degrees still uses sagittal planes, but there is no assessment of lumbar SFI degrees using axial planes Methods: Cross-sectional analytical observational study using secondary data; A total of 54 patients met the criteria for a lumbar MRI examination between January 2023 and December 2023. The conformity analysis among 2 categorical variables is presented in Cohen's Kappa plot (R). Results: The suitability of measurements based on axial planes to sagittal planes has an R value of 0.801; p <0.001) showed a near-perfect diagnostic fit in assessing lumbar SFI between axial and sagittal pieces and nonparametric test results using McNemar showed no difference in the ability to diagnose lumbar SFI degrees using axial and sagittal planes with a p value of 0.209 (p = < 0.5) Conclusion: There is an excellent fit between axial and sagittal planes in assessing grade of lumbar lumbar intervertebral foramen stenosis L4-5."

"ABSTRAKLatar belakang dan tujuan: MRI merupakan pemeriksaan paling sensitif untuk mengevaluasi herniasi diskus lumbalis. Kekurangan MRI adalah lamanya waktu pengambilan gambar dan kurangnya ketersedian diberbagai tempat. Pada institusi dengan keterbatasan alat dan jumlah pasien yang banyak hal ini dapat menyebabkan terjadinya stagnansi pasien. Maka perlu dipikirkan suatu studi alternatif pada MRI untuk mempersingkat waktu. Di RSCM, protokol terbatas belum menjadi standar, sehingga dibutuhkan penelitian untuk menilai sensitivitas dan spesifisitas MRI protokol terbatas pada diagnosis herniasi diskus lumbalis, stenosis kanalis spinalis lumbal, stenosis foraminal pada vertebra lumbalis.Metode: Uji diagnostik dengan pendekatan potong lintang untuk mengetahui sensitivitas dan spesifisitas protokol terbatas dalam mendiagnosis herniasi diskus, stenosis kanal spinalis dan stenosis foraminal pada vertebra lumbal pada 60 subyek.Hasil: Sensitivitas dan spesifitas MRI protokol terbatas pada diagnosis herniasi diskus, stenosis kanal spinalis, stenosis foraminal baik, yaitu 97,2% dan 95,2%, pada diagnosis herniasi diskus, 97,6% dan 96,6% pada stenosis kanal spinalis, dan 91,6% dan 92,6% pada stenosis foraminal.Kesimpulan: Sensitivitas dan spesifisitas MRI protokol terbatas pada diagnosis herniasi diskus, stenosis kanal spinalis dan stenosis foraminal baik, akan tetapi penggunaan secara luas perlu mempertimbangkan hal-hal lainnya seperti: pasien murni hanya herniasi diskus tanpa penyulit lainnya, menuntut kehadiran dokter spesialis radiologi pada saat pemeriksaan MRI berlangsung, dan protokol pemeriksaan MRI harus dibuat optimal.

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ABSTRACTBackground and purpose: MRI is the most sensitive examination to evaluate lumbar disc herniation. Disadvantages of MRI is the long duration of examination and the lack of availability of various places. At institutions with limited equipment and patient loads it can lead to stagnation of the patient. Then it should be considered an alternative to MRI studies to shorten the time. At RSCM, restricted protocols yet to be standarized, so that research is needed to assess the sensitivity and specificity of Limited Protocol MRI protocol in diagnosing of lumbar disc herniation, lumbar spinal canal stenosis, lumbar foraminal stenosisMethods: Diagnostic Test with cross sectional approach to determine the sensitivity and specificity of the protocol in diagnosing lumbar disc herniation, lumbar spinal canal stenosis, lumbar foraminal stenosis in 60 subjects.Results: The sensitivity and specificity of limited protocol MRI is good, that is 97.2% and 95.2%, in the diagnosis of lumbar disc herniation, 97.6% and 96.6% in the lumbar spinal canal stenosis and 91.6% and 92.6% at lumbar foraminal stenosisConclusion :Sensitivity and specificity of Limited Protocol MRI in diagnosising of a lumbar disc herniation, lumbar stenosis canal spinal and lumbar stenosis foraminal is good, but the widespread use need to consider other things such as: the diagnosis patient is purely a herniated disc without other complications, demanding the presence of radiologist during MRI examinations, and the protocol MRI examination should be made optimal."

"ABSTRAKPendahuluan. Penggunaan autograft dalam fusi interkorpus tulang belakangmasih menjadi pilihan utama, tetapi jumlah yang terbatas dan morbiditas padatempat donor mendorong penggunaan substitusi tulang. Kombinasi HA dan DBMmenjadi pilihan utama selain autograft dalam fusi interkorpus, namun hasil yang ada menunjukan variasi diantara jenis DBM. Tujuan penelitian ini untukmengevaluasi luaran klinis dan radiologis fusi interkorpus lumbal menggunakankombinasi DBM dan HA.Metode Penelitian. Penelitian ini merupakan prospektif cohort pada 35 pasienyang terbagi atas 18 pasien kelompok autograft dan 17 pasien kelompokkombinasi HA dan DBM. Pasien merupakan pasien spondilosis lumbal yangdiindikasikan untuk tindakan operatif. Evaluasi klinis pada masing-masingkelompok pasca operasi menggunakan VAS, JOA dan ODI yang dinilai padabulan ke-3, 6 dan 12. Evaluasi radiologis pada masing-masing berupa fusi dievaluasi dengan ct scan pada bulan ke-12. Karakteristik pasien seperti jeniskelamin, usia, riwayat merokok, level operasi, dan BMI juga dievaluasi.Temuan Penelitian. Dua orang ahli bedah orthopaedi tulang belakang melakukan operasi stabilisasi posterior dan TLIF. Terdapat 55 pasien (27 kelompok autograft, 28 kelompok kombinasi HA dan DBM) yang masuk ke dalam kriteria, 9 pasien dari masing-masing kelompok di eksklusi karena tidak dapat di follow up sampai 12 bulan. Perbandinagn skor VAS, JOA dan ODI diantara kedua kelompok tidak menunjukan perbedaan yang bermakna dengan nilai p masing-masing 0,599, 0,543 dan 0,780. Perbandingan fusi antara kelompok autograft dan kombinasi HA dan DBM menunjukan nilai p 1,000, sehingga tidak bermakna secara statistik.Simpulan Hasil luaran klinis dan radiologis pada penggunaan kombinasi HA danDBM dalam fusi interkorpus tidak menunjukan inferioritas bila dibandingkandengan autograft. Kombinasi HA dan DBM dapat dipertimbangkan sebagaialternatif bagi pasien spondilosis lumbal yang diindikasikan untuk tindakanoperatif.

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ABSTRACTIntroduction The use of autograft still remains a gold standard in lumbarinterbody fusion surgery, but the limited amount and donor site morbidityencourages the use of bone substitute. Combination of HA and DBM become amain choice other than autograft in lumbar interbody fusion, however there were variable result between DBM product. These research was aimed to evaluate the clinical and radiological outcome of interbody fusion using combination of DBM and HA.Methods A cohort prospective research was conducted in 35 patients that were divided into 18 autograft group patients and 17 combination of HA and DBM group patient. All the patients were diagnosed with lumbar spondylosis and indicated for surgery. Clinical evaluation on each group was evaluated using VAS, JOA and ODI on the 3rd, 6th and 12th month post operatively. Radiologic outcome of fusion was evaluated using ct scan on the 12th month. Other patient characteristic such as sex, age, smoking history, level operation dan BMI were also evaluated in this research.Results Two orthopaedic spine surgeon conducted the posterior stabilization and TLIF procedure. There were 55 patients (27 autograft group patients, 28combination of HA and DBM group patients) that was included according to the criteria, 9 patients on each group were excluded due to loss of follow up below 12 months. Comparison of VAS, JOA and ODI score between the two group did not show any difference that significant statiscally with the p value was 0.599, 0.543, and 0.780 each. Comparison of fusion rate between the two groups showed p value of 1.000 which was not significant statiscally.Conclusions Clinical and radiological outcome of combination of HA and DBMin lumbar interbody fusion did not show inferiority compared with autograft.Combination of HA and DBM can be considered as an alternative in lumbarspondylosis patient that need operative procedure"

"ABSTRAKPendahuluan. Penggunaan autograft dalam fusi interkorpus tulang belakang masih menjadi pilihan utama, tetapi jumlah yang terbatas dan morbiditas pada tempat donor mendorong penggunaan substitusi tulang. Kombinasi HA dan DBM menjadi pilihan utama selain autograft dalam fusi interkorpus, namun hasil yang ada menunjukan variasi diantara jenis DBM. Tujuan penelitian ini untuk mengevaluasi luaran klinis dan radiologis fusi interkorpus lumbal menggunakan kombinasi DBM dan HA.Metode Penelitian. Penelitian ini merupakan prospektif cohort pada 35 pasien yang terbagi atas 18 pasien kelompok autograft dan 17 pasien kelompok kombinasi HA dan DBM. Pasien merupakan pasien spondilosis lumbal yang diindikasikan untuk tindakan operatif. Evaluasi klinis pada masing-masing kelompok pasca operasi menggunakan VAS, JOA dan ODI yang dinilai pada bulan ke-3, 6 dan 12. Evaluasi radiologis pada masing-masing berupa fusi di evaluasi dengan ct scan pada bulan ke-12. Karakteristik pasien seperti jenis kelamin, usia, riwayat merokok, level operasi, dan BMI juga dievaluasi.Temuan Penelitian. Dua orang ahli bedah orthopaedi tulang belakang melakukan operasi stabilisasi posterior dan TLIF. Terdapat 55 pasien (27 kelompok autograft, 28 kelompok kombinasi HA dan DBM) yang masuk ke dalam kriteria, 9 pasien dari masing-masing kelompok di eksklusi karena tidak dapat di follow up sampai 12 bulan. Perbandinagn skor VAS, JOA dan ODI diantara kedua kelompok tidak menunjukan perbedaan yang bermakna dengan nilai p masing-masing 0,599, 0,543 dan 0,780. Perbandingan fusi antara kelompok autograft dan kombinasi HA dan DBM menunjukan nilai p 1,000, sehingga tidak bermakna secara statistik.Simpulan Hasil luaran klinis dan radiologis pada penggunaan kombinasi HA dan DBM dalam fusi interkorpus tidak menunjukan inferioritas bila dibandingkan dengan autograft. Kombinasi HA dan DBM dapat dipertimbangkan sebagai alternatif bagi pasien spondilosis lumbal yang diindikasikan untuk tindakan operatif.

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ABSTRACTIntroduction The use of autograft still remains a gold standard in lumbar interbody fusion surgery, but the limited amount and donor site morbidity encourages the use of bone substitute. Combination of HA and DBM become a main choice other than autograft in lumbar interbody fusion, however there were variable result between DBM product. These research was aimed to evaluate the clinical and radiological outcome of interbody fusion using combination of DBM and HA.Methods A cohort prospective research was conducted in 35 patients that were divided into 18 autograft group patients and 17 combination of HA and DBM group patient. All the patients were diagnosed with lumbar spondylosis and indicated for surgery. Clinical evaluation on each group was evaluated using VAS, JOA and ODI on the 3rd, 6th and 12th month post operatively. Radiologic outcome of fusion was evaluated using ct scan on the 12th month. Other patient characteristic such as sex, age, smoking history, level operation dan BMI were also evaluated in this research.Results Two orthopaedic spine surgeon conducted the posterior stabilization and TLIF procedure. There were 55 patients (27 autograft group patients, 28 combination of HA and DBM group patients) that was included according to the criteria, 9 patients on each group were excluded due to loss of follow up below 12 months. Comparison of VAS, JOA and ODI score between the two group did not show any difference that significant statiscally with the p value was 0.599, 0.543, and 0.780 each. Comparison of fusion rate between the two groups showed p value of 1.000 which was not significant statiscally.Conclusions Clinical and radiological outcome of combination of HA and DBM in lumbar interbody fusion did not show inferiority compared with autograft. Combination of HA and DBM can be considered as an alternative in lumbar spondylosis patient that need operative procedure"

"ABSTRAKPendahuluan Penggunaan tandur tulang lokal saat ini masih menjadi pilihan utama dalam tatalaksana fusi posterolateral pada kasus spondilosis lumbal di negara berkembang. Rendahnya tingkat fusi yang dihasilkan oleh tindakan ini mendorong penggunaan alternatif material lain. Penambahan aspirat sumsum tulang pada tandur tulang lokal dapat menjadi pilihan yang efektif dalam tatalaksana fusi posterolateral pada pasien spondilosis lumbal, namun saat ini belum ada data mengenai luaran klinis dari tatalaksana jenis ini di Indonesia. Metode Penelitian ini merupakan metode Kohort Retrospektif pada 38 pasien dengan tatalaksana fusi posterolateral dengan menggunakan tandur tulang lokal yang terbagi atas 19 pasien kelompok dengan penambahan aspirat sumsum tulang dan 19 pasien kelompok tanpa penambahan aspirat sumsum tulang. Seluruh pasien mendapatkan tindakan operasi setelah tindakan konservatif gagal dalam mengatasi keluhan nyeri. Evaluasi klinis pada masing-masing kelompok menggunakan skor IDO dinilai sebelum operasi, bulan ke-3 dan ke-6 setelah operasi. Hasil Tiga orang Ahli Orthopaedi Divisi Tulang Belakang melakukan operasi fusi posterolateral dan stabilisasi posterior. Perbandingan skor IDO sebelum operasi di antara kedua kelompok tidak menunjukan perbedaan yang bermakna. Tidak terdapat perbedaan bermakna rerata skor IDO pada kedua kelompok hingga bulan ketiga. Namun, perbandingan skor IDO pre operasi dan 6 bulan paska operasi menunjukkan kelompok dengan penambahan aspirat sumsum tulang akan menghasilkan rerata skor IDO lebih baik. Kesimpulan Luaran klinis pasien spondilosis lumbal yang menjalani fusi posteralateral menggunakan tandur tulang lokal dengan penambahan aspirat sumsum tulang menunjukkan hasil yang baik. Penambahan aspirat sumsum tulang pada fusi posterolateral menggunakan tandur tulang lokal dapat dipertimbangkan sebagai alternatif bagi pasien spondilosis lumbal yang diindikasikan untuk tindakan operatif.

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ABSTRACTIntroduction The use of local bone graft still a mainstay in posterolateral fusion surgery for lumbar spondylosis cases in developing countries. Low rates of fusion encourage the alternative use of other materials. The addition of bone marrow aspirates in the local bone graft may be an option in the treatment of posterolateral fusion in the lumbar spondylosis patients, however there is no data on the clinical outcomes of treatment of this procedure in indonesia. Methods A retrospective cohort study was conducted in 38 patients treated by posterolateral fusion using local autograft that were divided into 19 patients with addition of bone marrow aspirates and 19 patients without addition of bone marrow aspirates. All patients received surgery after conservative treatments failed to address the complaint of pain. Clinical evaluation in each group using ODI score assessed preoperatively, 3rd, and 6th month postoperatively. Results Three Orthopedic Spine Surgeon performed posterolateral fusion and posterior stabilization. Comparison of preoperative ODI score between the two groups showed no significant difference. There were no significant differences in ODI score mean in both groups in 3 months after surgery. However, the bone marrow aspirate group produced a better mean difference of ODI score after 6 months. Conclusions The clinical outcomes of lumbal spondylosis patients undergoing posteralateral fusion using local autograft with addition of bone marrow aspirate showed good results. The addition of bone marrow aspirates in posterolateral fusion using local bone graft can be considered as an alternative for lumbar spondylosis patients who are indicated for surgery. "

"Pendahuluan: Stenosis kanal lumbal (SKL) adalah gangguan yang disebabkan oleh penyempitan kanal spinal. Derajat penyempitan kanal spinal dapat ditentukan oleh kriteria Herzog yang diukur dengan pemeriksaan MRI. Tujuan penelitian ini adalah untuk mengetahui luaran klinis pasien SKL dengan berbagai derajat stenosis setelah dekompresi dan stabilisasi posterior.Metode: Penelitian ini menggunakan studi kohort retrospektif di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dari bulan Agustus hingga September 2017 dengan teknik total sampling. SKL diklasifikasikan berdasarkan kriteria Herzog. Luaran klinis diukur dengan menghitung skor ODI sebelum operasi dan satu tahun setelah operasi.Hasil: 39 subyek penelitian memiliki rerata usia 58,41±5,86 tahun dan terdiri dari 24 perempuan dan 15 laki-laki. Berdasarkan kriteria Herzog, subyek penelitian yang diklasifikasikan dalam derajat medium 12 (30,8%) dan severe 27 (69,2%). Nilai median skor ODI pada kelompok medium 57 dan severe 60. Setelah operasi, nilai median pada kedua grup turun menjadi 6. Secara statistik, terdapat perbedaan bermakna nilai skor ODI pada kelompok medium (p 0,002) dan kelompok severe (p 0,001), sebelum dan setelah operasi. Sementara itu, tidak ada hubungan bermakna antara skor Herzog dan ODI sebelum operasi (p 0,192) dan setelah operasi (p 0,249).Diskusi: Luaran klinis pasien SKL tergolong baik karena skor ODI mengalami penurunan setelah tindakan dekompresi dan stabilisasi posterior sehingga tindakan tersebut mempengaruhi luaran klinis pasien SKL.

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Background: Lumbar canal stenosis (LCS) is a disorder that caused by the narrowing of the spinal canal. The stage of narrowing is based on Herzog criteria measured from MRI examination. The aim of study was to know clinical outcomes of LCS patients in different stage of stenosis after decompression and posterior stabilization.Methods: This research used retrospective cohort study design and carried out at Cipto Mangunkusumo General Hospital from August to September 2017 with total sampling technique. LCS was classified based on Herzog criteria. Clinical outcome was measured by counting The ODI score before the operative procedure, and one year after the operative procedure.Results: All 39 subjects was 58.41±5.86 years old and consisted of 24 females and 15 males. Based on herzog criteria, the subjects are classified into medium 12 (30,8%) and severe stage 27 (69.2%). The median of ODI score at medium group was 57 and severe group 60. After operative procedure, the median of ODI score at each groups was decreased to 6. Statistically, there was a significant corelation bertween of ODI score in medium (p 0,002) and severe group (p 0,001), to pre and postoperative procedure. No significant correlation between herzog and ODI score preoperative (p 0,192) and postoperative (p 0,249).Discussions: The clinical outcome of LCS patients is good because the ODI score decreases after decompression and posterior stabilization so the procedure affects clinical outcomes of LCS patients."