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Paskal Rachman
Perancangan Lumbosacroiliac Prosthesis untuk Pasien Pengidap Chordoma = Lumbosacroiliac Prosthesis Design for Patients with Chordoma
"Penelitian ini difokuskan untuk desain prosthesis khusus pada kasus pasien yang terkena chordoma bagian tulang belakang lumbar 4, lumbar 5 dan tulang ekor. Chordoma merupakan salah satu golongan jenis kanker ganas dan langka, yang biasa ditemukan pada tulang belakang atau tulang tengkorak. Sebagai metode pengobatannya jika kanker belum menyebar keluar tulang, prosedur pengangkatan tulang yang terinfeksi dilakukan dan digantikan dengan sebuah tulang buatan (prosthesis). Metode perancangan dilakukan dengan menggunakan CT Scan data pasien, yang diolah menjadi model 3D dengan software Materialise Mimics, rekayasa 3D model dilanjutkan dengan menggunakan software Solidworks dan simulasi dengan ANSYS. Proses perancangan dilakukan dengan beberapa macam variasi desain, diantaranya model implan tulang dengan solid dan shell model yang terbagi menjadi beberapa komponen, penggunaan iliac screw lateral connector, modifikasi iliac screw locking head dan modifikasi iliac screw locking head dengan cross connector. Dari hasil analisa perhitungan dan simulasi konsep terbaik yang terpilih yaitu dengan nilai Peak von Mises Stress dominan terendah pada bagian iliac screw diantara jenis desain yang lain adalah desain dengan menggunakan locking head iliac screw yang menggunakan implan shell model lattice structure.
This study focused on the design of specific prosthesis in the case of patients affected by chordoma of the lumbar 4, lumbar 5 and coccyx of the spine. Chordoma is a group of types of malignant and rare cancers, commonly found in the spine or skull bones. As a method of treatment, if the cancer has not spread beyond the bone, the removal procedure is carried out and replaced with an artificial bone (prosthesis). The design method is carried out using CT Scan of patient data, which is processed into a 3D model with Materialise Mimics software, 3D model engineering is continued using Solidworks software and simulation with ANSYS. The design process is carried out with several kinds of design variations, including the bone implant model with a solid and shell model which is divided into several components, the use of iliac screw lateral connector, modification of iliac screw locking head and modification of iliac screw locking head with cross connector. From the analysis results of calculation and simulation the best concept chosen is the Peak von Mises Stress value which is the lowest dominant in the iliac screw section among other types of designs is the design using the iliac screw locking head with implant shell model lattice structure."
Depok: Fakultas Teknik Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Marpaung, Madeline F.N.
Prediksi kesulitan penempatan jarum spinal berdasarkan gambaran radiologis dan penanda anatomis pada pasien bedah urologi = Predicting the difficulty of spinal needle insertion using radiological characteristics of the lumbar vertebrae and spinal bony landmarks in urologic patients
"[ABSTRAK
Latar belakang. Penyuntikan berulang pada prosedur anestesia spinal berkaitan dengan tingginya angka komplikasi dan ketidaknyamanan pasien. Sistem prediksi praoperatif yang akurat terhadap kemungkinan kesulitan penempatan jarum spinal dapat membantu mengurangi insiden penyuntikan berulang sehingga mengurangi risiko komplikasi terhadap pasien. Penelitian ini bertujuan untuk mengetahui ketepatan prediksi kesulitan penempatan jarum spinal berdasarkan gambaran radiologis dan penanda anatomis pada pasien bedah urologi.
Metode. Penelitian ini bersifat observasional analitik terhadap pasien bedah urologi yang menjalani anestesia spinal di Rumah Sakit Cipto Mangunkusumo pada bulan April sampai Mei 2015. Sebanyak 109 subyek diambil dengan metode consecutive sampling. Data pasien (usia, jenis kelamin, indeks massa tubuh, status fisik, gambaran radiologis vertebrae lumbal, dan kualitas penanda anatomis tulang belakang), jumlah penusukan kulit dan redireksi jarum spinal, serta angka kesulitan penempatan jarum spinal dicatat. Kesulitan penempatan jarum spinal ditentukan berdasarkan jumlah penusukan kulit dan redireksi jarum spinal. Variabel yang signifikan ditentukan melalui uji Pearson?s Chi-square dan uji Fisher, kemudian analisis multivariat dengan metode regresi logistik digunakan untuk melihat hubungan antara kesulitan penempatan jarum spinal dengan variabel-variabel yang signifikan.
Hasil. Faktor usia memiliki hubungan yang bermakna hanya pada analisis bivariat (p=0,028). Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal memiliki nilai prediksi terhadap kesulitan penempatan jarum spinal (p=0,000 dan p=0,006). Hasil uji kalibrasi menunjukkan kualitas prediksi yang baik. Dari uji diskriminasi didapatkan AUC sebesar 0,84 (IK 95% 0,751-0,929).
Simpulan. Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal mampu memprediksi kesulitan penempatan jarum spinal dengan tepat pada pasien bedah urologi. ABSTRACT Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.
Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.
Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).
Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ;Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.
Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.
Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).
Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. , Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.
Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson’s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.
Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).
Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Christella Natali
Blok paravertebral lumbal teknik injeksi satu titik pada kadaver: penelitian volume zat pewarna metilen biru pada ruang paravertebra = Lumbar paravertebral block one injection technique volume methylene blue dye in paravertebra space study
"Latar Belakang: Anestesia blok saraf perifer merupakan teknik anestesia untuk memfasilitasi operasi daerah ekstremitas atas atau bawah khusunya pada pasien dengan masalah medis berat. Anestesia blok saraf perifer bawah minimal memerlukan dua injeksi, yaitu pada pleksus lumbalis dan sakralis. Pada penelitian yang dilakukan sebelumnya, didapatkan bahwa penyuntikkan 30 ml metilen biru pada ruang paravertebra lumbal 4 ternyata dapat menyebar ke ruang paravertebra L1 sampai S2. Berdasarkan penelitian tersebut maka penelitian ini dilakukan untuk mengetahui volume metilen biru yang dapat mencapai segmen L2 sampai S3 dengan teknik sekali injeksi.
Metode : Penelitian ini menggunakan metode up and down. Jumlah sampel maksimal ditentukan 20 kadaver. Volume awal yang ditentukan adalah 40 ml. Interval antar volume ditentukan 10 ml. Bila penyebaran metilen biru pada volume 40 ml mencapai ruang paravertebra L2 sampai S3, maka kadaver selanjutnya menggunakan volume metilen biru 30 ml, namun bila tidak didapatkan penyebaran ruang paravertebra L2 sampai S3, maka kadaver selanjutnya menggunakan volume 50 ml. Penelitian akan dihentikan bila memenuhi satu dari tiga ketentuan yaitu hasil konstan tercapai, tidak didapatkan penyebaran ruang paravertebra L2 sampai S3 pada volume maksimal 80 ml dan jumlah maksimal 20 kadaver tercapai.
Hasil : Dari kelima volume metilen biru yang diteliti, tidak didapatkan penyebaran ruang paravertebra L2 sampai S3. Segmen penyebaran tertinggi metilen biru pada ruang paravertebra L1 dengan volume 60 ml. Penyebaran terendah metilen biru didapatkan pada S1 dengan volume 60 ml dan 70 ml. Penyebaran kontralateral didapatkan pada volume 40 ml dan 70 ml.
Simpulan: Dari kelima volume zat pewarna metilen biru 1% belum ada volume yang menghasilkan penyebaran ruang paravertebra L2 sampai S3, dengan demikian tidak didapatkan volume minimum.
Background: Peripheral nerve blockade is a technique to facilitate lower or upper extremities surgery, specifically in patients with severe comorbidities. Peripheral nerve blockade for lower extremity needs at least two injections, each for lumbal plexus and sacral plexus blockade. Referring to the previous Prawiro?s study in 2013, a single injection of 30 ml of methylene blue in paravertebral space of L4 resulted in an ipsilateral spread from paravertebral space of L1 up to S2. This study aimed to determine the minimum volume of methylene blue to spread from paravertebral space of L2 up to S3.
Objective: To determine the minimum volume in a single injection of 1% methylene blue to spread from paravertebral space of L2 up to S3 at paravertebral space of L4.
Methods: This study used ?up and down? method with maximum sample of 20 cadavers. The initial injection volume was 40 ml with an interval of 10 ml. If the initial injection in the first cadaver spread from paravertebral space of L2 up to S3, then the next volume for the second cadaver would be 30 ml. If the initial injection did not spread from paravertebral space of L2 up to S3, then the next volume for the second cadaver would be 50ml. The study stopped when one of the 3 conditions had been achieved, i.e. constant result after injection, a maximum volume of 80 ml did not spread from paravertebral space of L2 up to S2, and all 20 cadavers had been used.
Results: None of the volume spread from the paravertebral space of L2 up to S2. The highest spread was at level L1 using 60 ml with the lowest was at level S1 using 60 ml and 70 ml. We found contralateral spread after using 40ml and 70ml. There seemed to be no correlation between the injected volume and the range of spread in lumbar paravertebral space.
Conclusion: None of the volume in a single injection of methylene blue spread from paravertebral space of L2 up to S3."
Depok: Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Wafa Husnayaini
Pengembangan Desain dan Fabrikasi Lumbar Interbody Fusion (LIF) Spine Cage Titanium = Design and Fabrication Development of Titanium Lumbar Interbody Fusion (LIF) Spine Cage
"Penyakit pada bagian punggung, khususnya pada bagian lumbar merupakan salah satu penyakit tulang belakang yang paling umum dialami oleh banyak orang. Di antaranya, sebagian besar disebabkan oleh kerusakan pada diskus. Jika penanganan konvensional tidak berhasil menghilangkan rasa sakit pasien, Teknik Lumbar Interbody Fusion Spine Cage banyak digunakan oleh dokter bedah tulang belakang untuk menangani kerusakan diskus. Dengan menggunakan material titanium yang memiliki sifat biologis yang baik, dapat dikembangkan desain struktur implan yang dapat meningkatkan sifat mekanik dari implan tersebut, yaitu dengan mengembangkan desain berbentuk mikroporus dan struktur lainnya. Namun, fabrikasi bentuk struktur porous pada titanium merupakan proses yang kompleks dan membutuhkan biaya yang mahal. Sehingga penelitian ini menggunakan metode lain, yaitu dengan CNC Milling untuk menghasilkan desain yang diinginkan dengan proses yang lebih mudah dan biaya yang lebih terjangkau. Dikembangkan desain berbentuk makroporous dan struktur truss, yang menunjukkan kekuatan kompresi yang mencapai kebutuhan implan, namun nilai modulus elastisitas yang ditargetkan untuk diturunkan tidak tercapai. Serta terdapat abnormalitas antara hasil pengujian dengan metode simulasi FEA dan eksperimental. Namun hasil temuan ini dapat diaplikasikan dengan menggabungkan material titanium dengan PEEK untuk mencapai nilai modulus elastisitas yang dibutuhkan. Serta didapatkan juga bahwa desain yang dikembangkan dapat menahan beban dengan efisien dan dapat diterapkan untuk metode fabrikasi 3D printing kedepannya.
Lower back pain, specifically in the lumbar segment, is one of the most common diseases of the spine, where most of it is caused by the intervertebral disc disease. If conventional treatment is not effective, Lumbar Interbody Fusion (LIF) Technique is used by many spine surgeons to treat disc diseases. By making use of titanium material that has great biological properties, a design can be developed to increase the mechanical properties of the implant by developing microporosity and other structures. Though, fabrication of a porous structure is complex and expensive. Hence in this research, a fabrication of porous titanium using CNC drilling method, is used for more affordable and simple methods. A macroporous and a truss structure design is developed in this research, which shows compressive strength that meets the implant requirements. Though the decrease of elastic modulus which is aimed is not achieved. There was also abnormality between the results of FEA simulation and experimental results. Despite the outcome, the findings can be applicated by combining titanium and PEEK material to achieve the elastic modulus needed. It was also found that the design developed can bear the load efficiently and can be applied in other fabrication methods such as 3D printing in the future."
Depok: Fakultas Teknik Universitas Indonesia, 2023
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UI - Skripsi Membership  Universitas Indonesia Library
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Paskal Rachman
Perancangan dan Rapid Prototyping Implan Lumbosacroiliac Untuk Pasien Pengidap Chordoma = Lumbosacroiliac Implant Design and Rapid Prototyping for Patients with Chordoma
"Penelitian ini merupakan proses dari pengembangan desain baru prostesis lumbal dan sakral berbasis antropometri populasi Indonesia yang berpotensi untuk diproduksi massal dan merupakan prostesis pertama di Indonesia yang memfasilitasi pelestarian saraf serta rekonstruksi parsial. Studi ini juga bertujuan untuk mengembangkan sebuah prototipe prostesis dengan aspek biomekanis yang dapat dikomparasikan dengan tulang yang ditujukan penggunaannya untuk pasien pengidap chordoma. Chordoma merupakan salah satu golongan jenis kanker ganas dan langka, yang biasa ditemukan pada tulang belakang atau tulang tengkorak. Sebagai proses pengobatannya adalah dengan pengangkatan tulang yang terinfeksi dan rekonstruksi dengan prostesis. Metode pengembangan dan perancangan dilakukan dengan tahapan identifikasi kebutuhan, pembuatan konsep, pemilihan konsep, pemilihan material, pengembangan detil desain dan tahapan akhir prototyping. Pada tahapan prototyping dilakukan uji fisik dan pemasangan pada cadaver menggunakan material PLA dan Aluminium serta uji virtual dengan Finite Element Method (FEM). Pada uji FEM, dihasilkan desain yang telah dikembangkan dapat memenuhi kriteria penggunaan sehari-hari dengan stress tertinggi sebesar 280.31 MPa dan safety factor 3.19 dimana yield strength material Ti-6Al-4V sebesar 895 MPa. Sedangkan dari hasil uji pemasangan, berdasarkan opini para ahli dibidang kedokteran menyimpulkan bahwa prostesis ini secara teknik operasi dan pemasangan dapat tercapai dengan baik serta bisa menjadi alternatif dari metode rekonstruksi yang ada.
This research is the process of developing a new design of the lumbar and sacral prosthesis based on Indonesian population anthropometry which has the potential to be mass produced and is the first prosthesis in Indonesia that facilitates nerve preservation and partial reconstruction. This study also aims to develop a prototype prosthesis with biomechanical aspects that can be compared to bone which is intended for use in patients with chordoma. Chordoma is a type of malignant and rare cancer, which is usually found in the spine or skull. As a treatment process is the removal of the infected bone and reconstruction with a prosthesis. The method of development and design is carried out with the stages of needs identification, concept creation, concept selection, material selection, development of design details and the final stage of prototyping. At the prototyping stage, physical and installation tests were carried out on the cadaver using PLA and Aluminium materials and virtual tests with the Finite Element Method (FEM). In the FEM test, the resulting design that has been developed can meet the criteria for daily use with the highest stress of 280.31 MPa and a safety factor of 3.19 where the yield strength of the Ti-6Al-4V material is 895 MPa. From the results of the installation test, based on the opinion of experts in the field of medicine, it was concluded that this prosthesis in terms of surgical and installation techniques can be achieved well and could be an alternative to existing reconstruction methods.  "
Depok: Fakultas Teknik Universitas Indonesia, 2021
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UI - Tesis Membership  Universitas Indonesia Library
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M.Ade Putra
Perbandingan Luaran Klinis dan Radiologis Degeneratif Lumbal Canal Stenosis yang Dilakukan Dekompresi Biportal Endoscopic Spine Surgery Discectomy dan tanpa Discectomy = Comparison of Clinical and Radiological Outcomes of Biportal Endoscopic Spine Surgery with Discectomy and without Discectomy in Degenerative Lumbar Canal Stenosis
"Pendahuluan Biportal Endoscopic Spine Surgery (BESS) merupakan salah satu metode minimal invasif untuk melakukan dekompresi struktur saraf pada Degeneratif Lumbal Canal Stenosis (DLCS). Teknik ini memiliki keunggulan dibandingkan teknik lainnya dalam preservasi jaringan lunak dan struktur posterior tulang belakang. Penambahan prosedur discectomy pada pembedahan terbuka diketahui akan menyebabkan penurunan tinggi diskus secara signifikan, mempercepat proses degenerasi pada diskus itu sendiri sehingga akan merubah biomekanika segmen vertebra dan menimbulkan nyeri bahkan instabilitas di kemudian hari. Untuk itu, dilakukan penelitian dengan membandingkan hasil luaran klinis dan radiologis pada DLCS yang dilakukan BESS dengan penambahan discectomy dan tanpa discectomy
Metodologi Penelitian ini mengambil data dari 48 subjek DLCS yang memenuhi kriteria inklusi yang telah menjalani prosedur BESS. Kemudian dibagi menjadi kelompok BESS discectomy sebanyak 24 subjek dan BESS tanpa discectomy sebanyak 24 subjek secara consecutive sampling. Pada masing-masing kelompok dinilai luaran klinis berupa skala nyeri Numerical Rating Scale (NRS) dan skor Oswestry Disability Index (ODI) pre dan 1 tahun pasca operasi. Luaran radiologis dinilai berupa tinggi diskus pada x ray lumbal lateral berdiri pre dan pasca 1 tahun operasi dan adanya instabilitas dinilai dari translasi sagittal dinamik, angulasi sagittal dinamik pada x ray lumbal dinamik berdiri 1 tahun pasca operasi
Hasil Dari 48 orang subjek pada penelitian ini, rerata usia sebesar 57.56+8.37, sebagian besar berjenis kelamin perempuan 31 (64.6%), dengan level stenosis terbanyak pada L4-5 yaitu sebesar 64.6%, diikuti L5-S1 sebesar 25% dan L3-4 10.4%. Pada kelompok BESS discectomy didapatkan perbedaan yang bermakna terhadap skala nyeri NRS back dan leg pain, skor ODI, serta penurunan tinggi diskus pre dan pasca operasi 1 tahun (p<0,001), begitu juga dengan kelompok BESS tanpa discectomy. Perbandingan perbedaan penurunan tinggi diskus antara kedua kelompok pasca 1 tahun operasi, menunjukkan perbedaan yang signifikan yaitu pada BESS discectomy dengan rerata 1,63 + 0,87 mm, sedangkan pada BESS tanpa discectomy sebesar 0,46 + 0,36 mm (p <0,001). Perbandingan terjadinya instabilitas tidak menunjukkan perbedaan yang bermakna antara kedua kelompok ( p=0,234)
Diskusi dan Kesimpulan Prosedur BESS pada kasus DLCS memberikan penurunan skala nyeri NRS back pain dan leg pain yang sama baiknya pada kelompok BESS discectomy dan BESS tanpa discectomy. Tidak didapatkan perbedaan terjadinya instabilitas pada kedua kelompok, meskipun didapatkan perbedaan penurunan tinggi diskus yang signifikan antara kedua kelompok setelah 1 tahun operasi.
Introduction Biportal Endoscopic Spine Surgery (BESS) is a minimally invasive method for decompressing nerve structures in Degenerative Lumbar Canal Stenosis (DLCS). This technique has advantages over other techniques in the preservation of soft tissue and posterior structures of the spine. The addition of a discectomy procedure to open surgery is known to cause a significant reduction in disc height, accelerate the degeneration process of the disc itself so that it will change the biomechanics of the vertebral segments and cause pain and even instability in the future. For this reason, research was conducted by comparing the clinical and radiological outcomes of DLCS performed by BESS with the addition of discectomy and without discectomy.
Materials and Methods This study took data from 48 DLCS subjects who met the inclusion criteria who had undergone the BESS procedure. Then divided into BESS discectomy group with 24 subjects and BESS without discectomy with 24 subjects using consecutive sampling. In each group, clinical outcomes were assessed in the form of the Numerical Rating Scale (NRS) pain scale and Oswestry Disability Index (ODI) scores pre and 1 year after surgery. Radiological outcomes were assessed in the form of disc height on standing lateral lumbar x-ray pre and post 1 year of surgery and the presence of instability was assessed from dynamic sagittal translation, dynamic sagittal angulation on standing dynamic lumbar x ray 1 year post surgery.
Results Of the 48 subjects in this study, the average age was 57.56+8.37, the majority were female 31 (64.6%), with the highest level of stenosis at L4-5 (64.6%), followed by L5-S1 at 25% and L3-4 10.4%. In the BESS discectomy group, there were significant differences in the NRS back and leg pain scales, ODI scores, and reduction in disc height pre and post-operatively 1 year (p<0.001), as well as in the BESS group without discectomy. Comparison of the difference in disc height reduction between the two groups after 1 year of surgery, showed a significant difference,in BESS discectomy with a mean of 1.63 + 0.87 mm, while in BESS without discectomy it was 0.46 + 0.36 mm (p <0.001 ). Comparison of the occurrence of instability did not show a significant difference between the two groups (p=0.234)
Discussion and Conclusion The BESS procedure in DLCS cases provided an equally good reduction in the NRS back pain and leg pain scales in the BESS discectomy and BESS without discectomy groups. There was no difference in the occurrence of instability in the two groups, although there was a significant difference in disc height reduction between the two groups after 1 year of surgery.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tugas Akhir  Universitas Indonesia Library
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Rahmi
Perbandingan efektivitas analgesia perioperatif antara blok thoracolumbal interfascial plane dengan blok erector spinae plane pada prosedur dekompresi dan stabilisasi posterior lumbal: kajian skala nyeri, konsumsi total opioid, kestabilan kardiovaskular = The comparison effectiveness of perioperative analgesia between thoracolumbar interfascial plane block and erector spinae plane block in decompression and posterior lumbar stabilization procedures: study of pain scale, total opioid consumption, cardiovasc
"Latar Belakang: Prosedur dekompresi dan stabilisasi posterior lumbal berhubungan dengan nyeri hebat pascabedah dan menghasilkan respon stress pembedahan. Blok ESP dan blok TLIP efektif sebagai analgesia perioperatif pada prosedur pembedahan tulang belakang. Penatalaksanaan nyeri pascabedah yang adekuat dapat mengurangi respon stres yang timbul akibat pembedahan.
Tujuan: Membandingkan efektifitas antara blok ESP dan Blok TLIP sebagai analgesia perioperatif pada prosedur dekompresi dan stabilisasi posterior lumbal terhadap skala nyeri, konsumsi total opioid, kestabilan kardiovaskular, kadar IL-6 dan IL-10 perioperatif.
Metode: Penelitian ini merupakan penelitian eksperimental, uji klinis acak tersamar ganda terhadap 40 subjek yang menjalani pembedahan dekompresi dan stabilisasi posterior lumbal di Instalasi Bedah Pusat RSUPN Dr. Cipto Mangunkusumo Jakarta dan RSUD dr Zainoel Abidin Banda Aceh. Subjek dirandomisasi dalam dua kelompok: kelompok blok ESP (n=20) dan kelompok blok TLIP (n=20). Kedua kelompok mendapat bupivakain 0,25% total volume 20 cc setiap sisi. Data yang diolah berupa skala nyeri NRS (Numerical rating scale) pada 1, 6, 12, 24 jam pascabedah, konsumsi morfin dalam 24 jam, jumlah fentanyl intraoperatif, waktu pemberian morfin pertama pascabedah, konsentrasi IL-6 dan IL-10 perioperatif. Analisis data menggunakan Uji t berpasangan dan Mann-Whitney.
Hasil: NRS pada 1, 6, 12, 24 jam pascabedah, konsumsi morfin dalam 24 jam, jumlah fentanyl intraoperatif, konsentrasi IL-6 dan IL-10 perioperatif tidak berbeda bermakna antra blok TLIP dan blok ESP (p>0,05). Waktu pemberian morfin pertama blok TLIP lebih lama bermakna daripada blok ESP (p=0,002).
Simpulan: Keefektifan blok TLIP tidak berbeda dengan blok ESP sebagai analgesia perioperatif pada prosedur dekompresi dan stabilisasi posterior lumbal.
Background: Posterior lumbar decompression and stabilization procedures are related with severe postoperative pain and produce a surgical stress response. ESP block and TLIP block are as effective as perioperative analgesia in spinal surgery procedures. Adequate postoperative pain management can reduce stress response caused by surgery.
Objective: To compare the effectiveness of ESP block and TLIP block as perioperative analgesia in posterior lumbar decompression and stabilization procedures and associated pain scale, total opioid consumption, cardiovascular stability, perioperative IL-6 and IL-10 consentrations.
Methods: This study was an experimental, double-blind, randomized controlled trial of 40 subjects who underwent decompression surgery and posterior lumbar stabilization at the Central Surgical Unit of RSUPN Dr. Cipto Mangunkusumo Jakarta and RSUD Dr Zainoel Abidin Banda Aceh. Subjects were randomized into two groups: the ESP block group (n=20) and the TLIP block group (n=20). Both groups received 0.25% bupivacaine with a total volume of 20 cc each side. The data were processed in the form of NRS pain scale (Numerical rating scale) at 1, 6, 12, 24 hours postoperatively, morphine consumption within 24 hours, amount of intraoperative fentanyl, time of first postoperative morphine administration, perioperative IL-6 and IL-10 concentrations. Data analysis used paired t test and Mann-Whitney.
Results: NRS at 1, 6, 12, 24 hours postoperatively, morphine consumption within 24 hours, amount of intraoperative fentanyl, perioperative IL-6 and IL-10 concentrations were not significantly different between TLIP block and ESP block (p>0.05). The time of administering the first morphine on TLIP block was significantly longer than ESP block (p=0.002).
Conclusion: The effectiveness of the TLIP block is no different from the ESP block as perioperative analgesia in decompression and posterior lumbar stabilization procedures."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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