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"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. "

"Latar Belakang. Spondilitis tuberkulosis adalah infeksi pada tulang belakang yang disebabkan oleh Mycobacterium tuberculosis. Spondilitis tuberkulosis dapat menyebabkan perubahan parameter-parameter spinopelvis yang meliputi pelvic incidence, pelvic tilt dan sacral slope akibat perubahan biomekanika pada tulang belakang. Segmen vertebrae torakal dan lumbar merupakan lokasi yang paling sering terkena spondilitis tuberkulosis. Instrumentasi posterior merupakan salah satu modalitas tata laksana spondilitis tuberkulosis. Namun, di Indonesia, data luaran klinis dan radiologi pasca instrumentasi posterior pada tuberkulosis lumbal masih langka. Studi ini bertujuan untuk mengetahui luaran klinis dan radiologis pasien spondilitis tuberkulosis lumbar sebelum dan sesudah instrumentasi posterior.Metode. Penelitian ini merupakan studi potong lintang pada pasien dengan spondilitis tuberkulosis lumbal di RS Cipto Mangunkusumo dan RSUP Fatmawati. Subjek penelitian dikumpulkan secara consecutive sampling. Total subjek yang dikumpulkan dan dianalisis berjumlah 23 pasien. Luaran klinis dan radiologis sebelum dan sesudah instrumentasi posterior akan dibandingkan. Luaran klinis yang dinilai meliputi skor Visual Analog Scale (VAS) dan skor Oswestry Disability Index (ODI). Luaran radiologis yang dinilai meliputi sacral slope, pelvic tilt, pelvic incidence, dan lumbar lordosis. Analisis statistik dilakukan dengan SPSS versi 20.Hasil. Median usia subjek penelitian adalah 31 (9-57) tahun. Sebanyak 60,9% subjek berjenis kelamin perempuan. Median jumlah vertebra yang terinfeksi adalah 2 (1- 4). Median skor VAS sebelum operasi, 6 bulan setelah operasi, dan 12 bulan setelah operasi secara berturut-turut adalah 9 (4 – 10), 4 (1-7), dan 2 (1-6) (p<0,001). Median skor ODI sebelum operasi, 6 bulan setelah operasi, dan 12 bulan setelah operasi secara berturut-turut adalah 70 (40 – 86), 34 (10 – 74), dan 12 (2 – 74) (p<0,001). Tidak ditemukan perbedaan bermakna parameter lumbar lordotic, pelvic incidence, pelvic tilt, dan sacral slope sebelum dan setelah operasi. Selisih skor ODI sebelum dan sesudah operasi berkorelasi negatif dengan selisih lumbar lordotic dan sacral slope.Kesimpulan. Instrumentasi posterior dapat meningkatkan luaran klinis pada pasien spondilitis tuberkulosis lumbal. Instrumentasi posterior tidak bermakna dari segi koreksi parameter spinopelvis. Perubahan lumbar lordotic dan sacral slope setelah dilakukan instrumentasi posterior memberikan hasil perbaikan kualitas hidup yang ditandai dengan berkurangnya skor ODI.

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Introduction. Spondylitis tuberculosis is an infection of the vertebrae caused by Mycobacterium tuberculosis. Spondylitis tuberculosis can cause changes in spinopelvic parameters including pelvic incidence, pelvic tilt, and sacral slope due to biomechanical changes of the spine. The thoracal and lumbar vertebrae are the most commonly affected segment in spondylitis tuberculosis. Posterior instrumentation is one of the modality for the treatment of spondylitis tuberculosis. However, in Indonesia, clinical and radiological outcomes after posterior instrumentation in tuberculosis of lumbar vertebrae is still scarce. This study aims to investigate the clinical and radiological outcomes of patients with spondylitis tuberculosis of the lumbar vertebrae after posterior instrumentation.

Method. This study was a cross sectional study in patients with spondylitis tuberculosis of the lumbar vertebrae who underwent posterior instrumentation in Cipto Mangunsukumo and Fatmawati Hospital. Subjects were collected through consecutive sampling. 23 subjects were collected and analyzed. Clinical and radiological outcomes before and after posterior instrumentation were compared. The clinical outcome included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The radiological outcome included sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. Statistical analysis was performed using SPSS version 20.

Result. The median of age of the subjects was 31 (9-57) years. The subjects consisted of 60,9% female. The median of the total vertebral infected was 2 (1-4). Median of VAS score before surgery, 6 months after surgery, and 12 months after surgery were 9 (4 – 10), 4 (1-7), dan 2 (1-6) (p<0,001) consecutively. Median of ODI score before surgery, 6 months after surgery, and 12 months after surgery were 70 (40 – 86), 34 (10 – 74), dan 12 (2 – 74) (p<0,001) consecutively. There was no significant difference in lumbar lordotic, pelvic incidence, pelvic tilt, and sacral slope before and after the surgery. The difference of ODI score before and after the surgery inversely correlated with the difference of lumbar lordotic and sacral slope.

Conclusion. Posterior instrumentation could improve clinical outcomes in patients with spondylitis tuberculosis of lumbar. Posterior instrumentation did not significantly associate with correction of spinopelvic parameter. Change of lumbar lordotic and sacral slope after posterior instrumentation led to improvement of quality of life marked by reduction of ODI score"