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Studi ini bertujuan untuk mengembangkan produk implant tulang belakang mono-aksial pedicle screw. Prototipe implan yang terdiri dari beberapa variasi desain geometri telah didesain dan difabrikasi menggunakan metode machining. Variasi prototipe terdiri dari 3 ukuran depth thread yang berbeda, 3 ukuran pitch yang berbeda, dan 2 variasi conical. Setelah dilakukan evaluasi geometri 2 dari 7 variasi prototipe implan pedicle screw tidak sesuai dengan bentuk desainnya, dan untuk 5 variasi lainnya memiliki penyimpangan <5% dari ukuran dimensi desain. Prototipe tersebut diuji dengan pengujian pull out, torsi, dan bending untuk mengetahui performanya. Hasil pengujian pull out tertinggi dihasilkan oleh variasi pitch dengan ukuran pitch 2,1 mm dengan nilai 1658, 25 N.  Untuk nilai pull out tertinggi pada variasi depth thread dimiliki oleh ukuran depth thread 0,9 mm dengan nilai 1563,5 N. Sedangkan untuk nilai torsi terendah dihasilkan oleh variasi pitch pada ukuran 2,1 mm sebesar 0,15 Nm, dan untuk untuk variasi depth thread pada ukuran 0,9 mm sebesar 0,59 Nm. Untuk pengujian bending dilakukan pada 1 variasi pedicle screw dengan beban nilai terbesar 707 N. Setelah dilakukan beberapa pengujian pada ke-7 variasi didapatkan bahwa faktor geometri desain pedicle screw dapat mempengaruhi secara signifikan maupun tidak signifikan.

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The aim of this study is to develop a mono-axial pedicle screw for spinal implants. The implant prototype, which had varied geometries and designs, was produced through machining. The variation in the prototypes consisted of 3 different thread depths, 3 different pitch lengths, and 2 different conical geometries. After evaluations were made on the prototypes, 2 of the 7 variant prototypes did not match its original design geometry and dimensions. Meanwhile, the other 5 prototypes had a <5% measurement deviation compared to its original design. The prototypes were all tested for its pull out, torsion, and bending capabilities to compare their performances. The highest measurement in the pull out test, in terms of pitch, was made by the prototype with the 2.1 mm pitch which resulted in a 1658.25 N measurement. In terms of the thread depth, the highest measurement in the pull out test was made by the prototype with the 0.9 mm thread depth which resulted in a 1563.5 N measurement. For the torsion test, in terms of pitch, the least torsion was made by the prototype with the 2.1 mm pitch resulting in a 1.5 Nm in torsion. As for the thread depth, the least torsion was done by the prototype with the 0.9 mm thread depth at 0.59 Nm in torsion. For the bending test, the highest load obtained was 707 N in one variation of the pedicle screw. Based on the results of the tests, it can be summarized that the geometric design of the pedicle screw may affect its perfomance significantly.

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"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."

"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."

"Saat ini sebagian besar produk implan yang beredar di Indonesia adalah produk impor. Kementerian Kesehatan dan Kementerian Riset,Teknologi,dan Pendidikan Tinggi mendorong produksi produk implan dalam negeri supaya bisa menjadi alternatif produk implan yang selama ini didominasi oleh produk impor. Penelitian ini bertujuan untuk mengetahui kemampuan pullout dan torsi dari screw domestik yang telah dibuat dengan mengacu kepada STM F-543 tentang metode pengetesan untuk screw tulang. Spesifikasi screw yang digunakan dalam penelitian ini adalah screw titanium berukuran M1.5 yang digunakan untuk fiksasi pada area maksilofasial. Performa pullout dicari dengan menggunakan cara eksperimen, finite elemen, dan matematikal. Performa pullout screw domestik kemudian dibandingkan dengan performa screw impor. Sedangkan untuk performa torsi hanya dilakukan dengan cara eksperimen kemudian dibandingkan dengan performa dari screw impor.Hasil yang didapatkan menunjukkan bahwa nilai pull out screw domestik adalah 10,02 N dan screw impor 11,88 N. Nilai screw domestik dibandingkan dengan hasil finite elemen menunjukkan bahwa terjadi error sebesar 10,30. Sedangkan dengan menggunakan analitikal menggunakan chapman yang dimodifikasi didapat nilai sebesar 10,12 N atau error sebesar 1 Dari nilai yang didapat menunjukkan bahwa performa pullout screw domestik lebih buruk dari screw impor. Untuk performa torsi kedua screw menunjukkan performa yang sama baiknya yaitu 0,029 Nm untuk screw domestic dan 0,028 Nm untuk screw impor. Akan tetapi screw domestik membutuhkan gaya yang lebih besar untuk dipasang karena memiliki ujung yang lebih tumpul dari screw impor.

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Currently, the most of implant products that sold at Indonesia are imported product. The Ministry of Health and the Ministry of Research, Technology and Higher Education stimulate domestic implant production as an alternative for imported products that have been dominating domestic market. This study aims to observe domestic titanium screw performance especially from torque and pull out performance based on ASTM F 532 about test method for metallic bone screw. The implant spesification that observed is screw M1.5 for maxillofacial region. Those performances are tested using experimental approach, Finite Element Analysis FEA, and mathematical approach for pull out and only experimental approach for torque test.

The results of this study show that the value of pull out from domestic titanium screw UI and commmercial screw respectively are 10,02 N and 11,88 N. This result for domestic screw UI is not slightly different from result which using FEA approach with error 10,30 for pull out. In the other hands, mathematical approach using chapman modified method give error 1 for pull out. The result of this study shows that the value of pull out performance of domestic titanium screw is a little bit worse than imported commercial product. For torwque performance, domestic screw UI has value 0,029 Nm which is as good as commercial screw with value 0,028 Nm. But, domestic screw needs more force to drive the screw into test block because it has duller tip than commercial screw."

"On March 2nd 2000, a female patient age 47 years, originally had crown & bridges on region 22,,23,24,25,26, region 33,34,35,36,37, region 44,45,46,47. And region 13,14,15,16. She had suffered her abutments teeth as anchorages which initially healthy, then became caries, offtently swelling, pain, halitosis and finally several of its had pulled out. Formerly she asked removable denture on her edentulous ridges, then I had made her Valplast Denture. But the denture still felt uncomfortable and seldom be used. After suggesting the other alternative to use implant denture, on region 35,37 with ITI Straumann to make crown and bridge inplant denture with dummy 36, patient feltsatisfied. Then patient asked another crown and bridges which had problems to be pulled out too. Finally on 5 th February 2008 she had already completely installed combination implant denture ITI Straumann and Biohorizon although it takes along time periode, but now she feels satisfy, because she has fixed denture without sacrifice another healthy teeth as anchorages."

"Kehilangan gigi telah menjadi salah satu permasalahan yang umum untuk ditemukan di Indonesia, dengan angka sekitar 19% kasus gigi hilang akibat dicabut ataupun tanggal sendiri. Untuk mengatasi permasalahan kehilangan gigi, implan gigi merupakan alternatif yang banyak digunakan karena sudah terbukti dapat memberikan hasil yang baik secara jangka panjang. Keberhasilan pemasangan implan gigi dinilai berdasarkan tingkat stabilitasnya, yang terbagi kembali menjadi stabilitas primer dan stabilitas sekunder. Kedua jenis stabilitas tersebut saling berkaitan. Kekhawatiran akan pemasangan implan gigi banyak ditemukan pada kasus dimana pemasangan dilakukan pada pasien dengan tulang berkepadatan rendah. Tulang tempat terpasangnya implan gigi yang memiliki kualitas dan kepadatan yang kurang baik memiliki risiko kegagalan implan yang lebih tinggi. Untuk dapat meningkatkan tingkat stabilitas implan, banyak dilakukan proses modifikasi desain dan permukaan implan gigi, seperti penambahan fitur self-tapping dan peningkatan kekasaran permukaan badan implan. Fabrikasi dilakukan untuk menghasilkan purwarupa implan gigi dengan variasi sudut kemiringan dan panjang cutting flute, sebagai bagian dari fitur self-tapping. Purwarupa akan melalui proses surface treatment untuk mendapatkan tingkat kekasaran yang optimum untuk penggunaannya pada tulang berkepadatan rendah. Purwarupa akan diuji dengan uji torsi insersi dan uji pull-out test. Purwarupa 1 menunjukkan performa terbaik dengan nilai kekasaran permukaan sebesar 1,0636 μm, serta nilai insertion torque value dan pull-out load sebesar 22,4415 Ncm dan 317,068 N.

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Tooth loss has become a common health issue in Indonesia, with approximately 19% of cases resulting from extraction or natural loss. Dental implant are widely used as an alternative due to their proven long-term effectiveness. The success of dental implant placement is evaluated based on its stability, which can be categorized as primary stability and secondary stability. Both types of stability are interrelated with one another. Concerns about dental implant placement are often encountered when dealing with patients with low bone density. Poor quality and low-density bone in the implant insertion site might result in a higher risk of implant failure. To improve implant stability, various modifications are made to the design and surface of the implant body, such as adding self-tapping features and increasing the surface roughness of the implant body. Fabrication is done to produce dental implant prototypes with variations in in angulation and length of the cutting flute, as a part of the self-tapping feature. These prototypes will undergo surface treatment to achieve an optimal level of surface roughness for use in low bone density. Each prototypes are then tested using insertion torque test and pull-out tests. Prototype 1 showed the best performance with a surface roughness value of 1,0636 μm, as well as an insertion torque value of 22,4415 Ncm and a pull-out load of 317,068 N."

"Kondisi kehilangan gigi dapat menyebabkan gangguan pada efisiensi pengunyahan dan berdampak pada penyakit sistemik. Penggunaan implan gigi menjadi perawatan terbaik dengan manfaat jangka panjang. Untuk mencapai kesuksesan pemasangan implan gigi, produk implan gigi harus memiliki desain optimal guna mempercepat proses osseointegrasi. Alternatif yang dapat meningkatkan osseointegrasi dengan memodifikasi permukaan implan yang berpori. Penelitian ini akan berfokus pada simulasi, desain, dan manufaktur dari screw implan gigi berpori dengan prinsip hybrid porous dimana terdiri dari inti implan gigi yang padat dengan permukaan profil ulir yang berpori. Proses manufaktur akan menggunakan metode metal injection molding (MIM) yang melalui tahapan injeksi, debinding, dan sintering. Hasil green part dari injeksi menggunakan feedstock Ti-6Al-4V yang telah dilakukan menunjukkan adanya kecacatan produk pada profil ulir dan short shot. Proses dilanjutkan ke tahap debinding yang terdiri dari solvent debinding dan thermal debinding. Terakhir, proses sintering dilakukan dengan temperatur 1150°C dan waktu tahan 60 menit. Evaluasi pengamatan mikrostruktur dilakukan untuk mengetahui penampakan dari permukaan berpori yang diketahui memiliki %area porositas sebesar 36.268% untuk produk screw Ti-6Al-4V implan gigi trial.

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The condition of tooth loss can disrupt chewing efficiency and have systemic implications. The use of dental implants provides the best long-term treatment option. To achieve successful dental implant placement, the dental implant products must have an optimal design to expedite the osseointegration process. An alternative approach to enhance osseointegration is through modifying the implant surface to incorporate porosity. This study focuses on the simulation, design, and manufacturing of porous screw dental implants using the hybrid porous principle, consisting of a solid core implant with a porous threaded surface. The manufacturing process involves metal injection molding (MIM) with stages of injection, debinding, and sintering. The results of the injection process using Ti-6Al-4V feedstock revealed product defects in the threaded profile and short shots. The process then proceeds to the debinding stage, which includes solvent debinding and thermal debinding. Lastly, sintering is conducted at a temperature of 1150°C and a holding time of 60 minutes. Microstructure observations are performed to examine the appearance of the porous surface, which is known to have a porosity area percentage of 36.268% for the trial Ti-6Al-4V screw dental implant product."

"Implan gigi merupakan perawatan medis bagi gigi tanggal yang diakibatkan oleh berbagai kelainan periodontitis, maupun karies, trauma, serta kelainan pada perkembangan dan genetik, dengan tingkat keberhasilan mencapai 95% ditandai oleh kemampuan implan gigi melakukan osseointegrasi. Osseointegrasi dipengaruhi oleh beberapa hal, termasuk kualitas dan kuantitas tulang, serta desain implan gigi. Kegagalan implan gigi dapat terjadi pada tulang dengan kualitas lebih rendah akibat kelelahan yang berlebihan, serta desain implan gigi yang tidak memadai. Pada beberapa penelitian yang telah dilakukan, menunjukkan bahwa fitur self-tapping memiliki tingkat keberhasilan yang sama dengan implan gigi tanpa fitur ­­self-tapping, namun dengan torsi insersi yang lebih sederhana, sehingga dapat mengurangi risiko kerusakan tulang dan meningkatkan stabilitas primer dengan meminimalisir jumlah drilling yang digunakan. Penelitian ini dilakukan dengan melakukan simulasi finite element pada variasi desain cutting flute, berupa sudut kemiringan celah pemotong, panjang celah pemotong, dan jumlahnya, untuk menjalankan fungsi self-tapping. Simulasi ini dijalankan dengan memberikan pembebanan oklusal pada implan gigi yang dipasang pada tulang berdensitas rendah (tulang tipe III). Dari simulasi tersebut, dilakukan analisis distribusi tegangan dan strain yang terjadi pada implan gigi. Desain implan gigi dengan tiga buah celah pemotong dengan sudut kemiringan 5? di sepanjang badan implan yang berulir memiliki nilai tegangan Von Mises maksimum paling rendah, sebesar 92,127 MPa, bersesuaian dengan nilai strain maksimum paling rendah, yaitu 0,000555.

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Dental implant is a medical treatment for missing tooth caused by various conditions such as periodontitis, cavities, trauma, as well as abnormalities in growth and genetics, with a success rate of up to 95%, characterized by the ability of dental implants to achieve osseointegration. Osseointegration is affected by several factors, including the quality and quantity of bone, as well as the design of dental implants geometry. Dental implants failure can occur in lower quality bone due to excessive fatigue and inadequate implant design for acquired conditions. Research indicates that self-tapping features have the same success rate as dental implants without self-tapping features, but offer simpler insertion torque, reducing the risk of bone damage and improving primary stability by minimizing the drilling procedures. This study was conducted by performing finite element simulations on various cutting flute design, including the angle of the cutting flute, length of the cutting flute, and the number of cutting flute, to provide a self-tapping function. The simulation was conducted by applying occlusal loading to dental implants placed in low-density bone (bone type III). From the simulation, an analysis of stress distribution and strain in dental implants. Among the developed dental implant designs, the one featuring three cutting flutes at a 5? angle along the threaded implant body exhibits the lowest maximum Von Mises stress value of 92,127 MPa, as well as the lowest maximum strain value of 0,000555."

"Pendahuluan: Operasi fusi tulang belakang adalah penanganan definitif yang dilakukan untuk mengembalikan stabilitas struktural tulang belakang. Sel punca mesenkimal (SPM) telah diteliti mempunyai kemampuan untuk menyembuhkan defek pada metafisis tulang dan fusi vertebra. Saat ini, terdapat keterbatasan studi yang menilai capaian fusi vertebrae pada pasien dengan SPM. Metode: Studi ini menggunakan desain systematic review berdasarkan metode Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) yang dilakukan pada Juni 2020. Data dianalisis mengikuti panduan dari Cochrane Handbook for Systematic Reviews of Interventions dan menggunakan software Review Manager (RevMan, V.5.3). Hasil: Dari 11 studi yang memenuhi kriteria inklusi dan eksklusi, ditemukan perbaikan radiologis yang signifikan pada 3 studi RCT ini yakni OR: 2,46 (95% IK: 1,29-4,68; I2: 68%) pada pemeriksaan CT scan dan 2 studi RCT OR: 3,91 (95% IK: 1,92-7,99; I2: 0%) pada pemeriksaan X-ray. Pada studi pre dan post ditemukan 100% pasien mengalami perbaikan radiologis pada akhir studi. Perbaikan klinis nyeri berbeda bermakna pada pasien dalam waktu 3 bulan pasca tindakan pemberian stem sel dan bertahan dalam waktu 6-12 bulan. Perbaikan hambatan fungsi dengan penilaian skor ODI bermakna dalam 6 bulan pasca tindakan. Efek samping yang banyak ditemukan adalah nyeri. Kesimpulan: Penggunaan sel stem mesenkimal menghasilkan perbaikan radiologis, klinis, dan fungsi yang signifikan pada pasien dengan penyakit tulang belakang degeneratif.

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Introduction: Spinal fusion surgery is a definitive treatment to restore spinal structural stability. Although allograft is a gold standard for vertebral fusion, this method associates with high morbiidy. Based on previous studies, mesenchymal stem cell has ability to fix defect of metaphyses of bone and has a role in vertebral fusion. However, studies about vertebral fusion in patient treated with mesenchymal stem cell are still limited. Method: This study was a systematic review which was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) on June 2020. Data was analysed with guidance from Cochrane Handbook for Systematic Reviews of Interventions using Review Manager (RevMan, V.5.3) software. Results: From 11 studies which satisfy inclusion and exclusion criteria, there were significant radiological improvement in 3 RCT study on CT scan (OR: 2,46 95%CI: 1,29-4,68; I2: 68%) and 2 RCT study on X-Ray examination (OR: 3,91 95%CI: 1,92-7,99; I2: 0%). On pre and post study, 100% of patients showed significant improvement. The pain improved significantly 3 months after the procedure. Functional ability improved within 6 months after the surgery. The most common side effect reported was pain. Conclusion: Mesenchymal stem cell resulted in significant improvement of radiological, clinical, and function of patients with degenerative spinal disease."

"[Latar Belakang: Anestesia spinal pada wanita hamil sangat dipengaruhi oleh posisi pasien. Pendant position merupakan posisi yang baru diperkenalkan pada laporan kasus. Penelitian ini bertujuan untuk membandingkan keberhasilan penempatan jarum spinal pada usaha pertama antara pendant position dengan traditional sitting position untuk pasien yang menjalani pembedahan Sesar.Metode: Penelitian ini adalah uji klinik Randomized Controlled Trial (RCT), dilakukan secara terbuka (tidak tersamar). Subjek dilakukan randomisasi untuk menentukan perlakuan pendant position atau traditional sitting position. Keberhasilan penempatan jarum spinal dinilai dari jumlah usaha, jumlah kontak tulang dan lama waktu penempatan jarum spinal.Hasil: Sebanyak 308 subjek penelitian, tidak ada yang termasuk kriteriapenolakan dan pengeluaran. Keberhasilan penempatan jarum spinal pada usaha pertama untuk pendant position lebih baik (142 subjek (92%) vs 121 subjek (78%), p 0,001), total jumlah kontak tulang lebih sedikit (185 vs 421, p<0,001) dan median lama waktu yang dibutuhkan untuk penempatan jarum spinal lebih cepat ( 9 (4-350) vs 12 (5-486) detik, p<0,001) jika dibandingkan dengan traditional sitting position.Simpulan: Pendant position lebih baik dalam hal keberhasilan penempatan jarum spinal pada usaha pertama untuk pasien yang menjalani pembedahan Sesar jika dibandingkan traditional sitting position., Background: Spinal anesthesia in pregnant women is strongly influenced by the position of the patient. Pendant position is a new position introduced in the case report. This study aimed to compare the successful placement of spinal needle on the first attempt between pendant position and traditional sitting position for patients who underwent sectio Caesarean.Methods: The study was a randomized controlled trial (RCT), conducted openly (not blind). Subject randomization to determine treatment pendant position or traditional sitting position. The successful placement of spinal needle judged from the number of first attempt, the amount of bone contact and the duration of the placement of spinal needle. Results: A total of 308 subjects, none of which include criteria for exclusion and drop out. The successful placement of spinal needle on the first attempt of pendant position is better (142 subjects (92%) vs. 121 subjects (78%), p 0.001), the total amount of bone contact is less (185 vs. 421, p <0.001) and the median length of time required for placement of spinal needle is faster (9 (4-350) vs. 12 (5-486) seconds, p <0.001) when compared to the traditional sitting position.Conclusion: Pendant position is better in terms of the successful placement of spinal needle on the first attempt for a patient who underwent sectio Caesarean compared to traditional sitting position.]"