Trauma Medula Spinalis

Muhamad Yunus

Bedah Saraf FK Malahayati

Tulang Belakang Normal
Tulang belakang, 33
ruas
7 servikal
12 torakal
5 lumbal
Fusi sakral & koksik
Medula Spinalis
Dari batang otak
sampai vert. L1
Diameter : 10-13
mm
Di dlm kanalis
spinalis
Radiks
Sensoris & motoris
Refleks
Picture
 The dorsal roots of
spinal nerves
contain afferent (or
sensory) fibers.
The ventral roots of
spinal nerves
contain efferent (or
motor) fibers.
Trauma Medula Spinalis
Diagnosis trauma medula spinalis:
Anamnesis
Pemeriksaan Fisik
Umum
Pemeriksaan neurologis
Trauma Medula Spinalis
Mekanisme trauma servikal :
1. Hiperekstensi
2. Fleksi
3. Kompresi
4. Fleksi-kompresi dengan
distraksi posterior
5. Fleksi-rotasi
6. Horisontal-translasi
Trauma Medula Spinalis
Mekanisme trauma torakolumbal :
1. Fraktur prosesus transversus
2. Ekstensi
3. Fraktur kompresi wedge
4. Fraktur burst
5. Trauma jack-knife
6. Fraktur dislokasi
Trauma Medula Spinalis

Umum :
Posisi netral
Pasien sadar / tidak sadar
Flaccid areflexia
Pernafasan diafragma
Bisa fleksi elbow, ekstensi (-)
Hipotensi + bradikardi, hipovolemik (-)
Priapismus
Trauma Medula Spinalis
Pemeriksaan neurologis :
1. Motorik
Traktus kortikospinal
2. Sensorik
Traktus spinotalamikus
3. Refleks
Posterior collum
4. Otonom

Lesi komplit spinal cord

Lesi inkomplit spinal cord
 Imaging
X-ray examination
CT-Scan
MRI
 The Lateral
Cervical Spine X-
Ray
Trauma Medula Spinalis
Lesi spinal cord :

Trauma

Komplit Inkomplit
1. Anterior cord syndrome
2. Central cord syndrome
3. Brown-Sequard syndrome
4. Posterior cord syndrome
Picture
 Diagnosis klinis
A: complete
B: incomplete: sensory but not motor
function is preserved below the
neurological level and includes the sacral
Axial pain
segments S4-S5
Radikulopati C: incomplete: motor function is preserved
Parese : para, below the neurological level, and more than
tetra half of key muscles below the neurological
level have a muscle grade less than 3
Plegi : para, tetra strength
D: incomplete: motor function is preserved
below the neurological level, and at least
half of key muscles below the neurological
level have a muscle grade of 3 or more
strength
E: normal
Trauma Medula Spinalis
Spinal shock :
Terjadi sesudah trauma spinal cord

Fungsi spinal cord (-)

Flaccid
Refleks Babinski (-)
Refleks hiperaktif (-)
Trauma Medula Spinalis
Efek terhadap organ lain :
Paralisis interkostalis hipoventilasi
Paralisis diafragma C3-C5
Trauma abdomen masking effect
Trauma Medula Spinalis
Penatalaksanaan :
Umum :
Tekanan sistolik diperhatikan
Log-rolled pada matras
Khusus :
Medikamentosa
Konservatif
Operatif
Trauma Medula Spinalis
Penatalaksanaan khusus :
Medikamentosa :
Metilprednisolon < 8 jam
30 mg/kgBB, IV, 1 jam pertama
5,4 mg/kgBB drip dalam 23 jam
Trauma Medula Spinalis
Defisit Neurologis

(-) : Konservatif
(+)
Operatif :
Dekompresi
Stabilisasi anterior/posterior
Terima Kasih