Awake Endospine Disektomi pada Pasien Lumbar Spinal Stenosis karena Hernia Nucleus Pulposus

Nuzulul Widyadining Laras, Himawan Sasongko

Abstract


Lumbar spinal stenosis (LSS) merupakan gejala penyakit yang berhubungan dengan berkurangnya ukuran canalis spinalis vertebra lumbal menyebabkan penekanan saraf yang terletak di dalamnya. Berdasar penyebabnya dibagi jadi dua, kongenital dan degeneratif. Pasien dapat merasakan fase nyeri yang tidak dapat diprediksi dan juga fase stabil tanpa nyeri. Salah satu contoh LSS degeneratif adalah pembengkakan diskus intervertebralis atau HNP. Penyakit HNP merupakan salah satu penyebab dari nyeri punggung bawah dan merupakan salah satu masalah kesehatan yang utama. Prevalensi HNP berkisar antara 1–2 % dari populasi. Terapi yang dilakukan salah satunya endospine disektomi. Operasi ini dapat dikerjakan dengan general anestesia (GA) atau neuroaksial anestesia (spinal, epidural). GA lebih dipilih karena lebih aman dari komplikasi gangguan jalur nafas. Deksmedetomidine memiliki efek sedasi tanpa risiko depresi respirasi serta memiliki efek analgesi dapat digunakan untuk metode awake endospine pada disektomi. Pada penulisan ini, dilakukan pemilihan teknik anestesi awake untuk mengakomodasi operator untuk menilai respon nyeri dan fungsi motorik pasien saat operasi.

 

Awake Endospine Dissectomy in Patient with Lumbar Spine Stenosis caused by Hernia Nucleus Pulposus

Abstract

Lumbar spinal stenosis (LSS) are symptoms from degradation canalis spinalis vertebrae’s size which pressured nerve inside it. Based on its cause, there are two types of LSS, congenital and degenerative. The patient can experience an unpredictable pain phase as well as a stable phase without pain. Bulging of intervertebralis disc or HNP is one of degenerative LSS. HNP disease is one of the causes of low back pain and is a major health problem. HNP prevalention is 1-2 % from population. One of therapy use to medicate LSS is endospine discectomy. This operation done with general anesthesia (GA) or neuroaxial anesthesia (spinal, epidural). GA preferably used because it caused less side effect like airway obstruction or neural injury. Dexmedetomidine has a sedative effect without the risk of respiratory depression and has an analgesic effect. It can be used to awake endospine methods in dissectomy. In this case report, the writer did awake endospine method to accommodate operator so they could know level of pain and motoric function of patient durante operation.


Keywords


Lumbar spinal stenosis, hernia nucleus pulposus, endospine disektomi, awake anestesi, Lumbar spinal stenosis, hernia nucleus pulposus, endospine dissectomy, awake anesthesia

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References


Ciricillo SF, Weinstein PR. Lumbar spinal stenosis. West J Med 1993 Feb;158(2):171–7.

Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine 1995 May 15;20(10):1178–86.

Johnsson KE, Rosen I, Uden A. The natural course of lumbar spinal stenosis. Clin Orthop Relat Res 1992 Jun;279:82–6.

Herno A. Spinal Stenosis without deformity: Nonoperative treatment. In: Herkowitz HH, Dvorak JJ., Bell G, Nordin M, Grob DD, editors. The Lumbar Spine. Philadelphia: Lippincott Williams & Wilkins; 2004, 490–4.

Sairyo K, Biyani A, Goel V, Leaman D, Booth R Jr, Thomas J, et al. Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments. Spine 2005 Dec 1;30(23):2649–56.

Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine 2000;25(3):389–94.

Dorland WAN. Kamus Saku Kedokteran Dorland Edisi Bahasa Indonesia. Jakarta: Penerbit Buku Kedokteran EGC;2011, 505 3.

Company Saunder. B. W. Classification, diagnostic imaging, and imaging characterization of a lumbar. Volume 38. 200 4.

Wirawan. Nyeri Pinggang. Dalam: Nyeri : Pengenalan dan Tatalaksana. Semarang: Badan Penerbit Universitas Diponegoro; 1996:93–99

Matsumoto M, Watanabe K, Tsuji T, Ishii K, Takaishi H, Nakamura M, et al. Nocturnal leg cramps: a common complaint in patients with lumbar spinal canal stenosis. Spine 2009 Mar 1;34(5):E189– 94.

Inui Y, Doita M, Ouchi K, Tsukuda M, Fujita N, Kurosaka M. Clinical and radiologic features of lumbar spinal stenosis and disc herniation with neuropathic bladder. Spine 2004 Apr 15;29(8):869–73.

Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slatis P. Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. Calcif Tissue Int 1992 May;50(5):400–3.

Podichetty VK, Segal AM, Lieber M, Mazanec DJ. Effectiveness of salmon calcitonin nasal spray in the treatment of lumbar canal stenosis: a double-blind, randomized, placebo-controlled, parallel group trial. Spine 2004 Nov 1;29(21):2343–9.

Tafazal SI, Ng L, Sell P. Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. Eur Spine J 2007 Feb;16(2):207–12.

John FB, David CM, John DW. Morgan & Mikhail’s Clinical Anesthesiology 5th edition. New York. Mc-Graw Hill Education. 2013

Cormack JR, Orme RM,Costello TG. “The role of alpha2-agonists in neurosurgery”. Journal of Clinical Neuroscience. 2005; 12 (4): 375-8.

Laura P, Teresa G, Paolo F, Giovanni L, Gabriele F, Alberto Z. Dexmedetomidine as a sedative agent in critically ill patients: a meta-analysis of randomized controlled trials. PLOS ONE. 8(12):e82913




DOI: https://doi.org/10.24244/jni.v9i3.282

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