LAPORAN PENDAHULUAN RADIKULOPATI
YAYAN HERYANTO PROFESI NERS
SEKOLAH TINGGI ILMU KESEHATAN YPIB MAJALENGKA Jalan Gerakan Koperasi No!!" Ma#alen$ka %&%'' (!')
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RADIKULOPATI
I. Pengertian
Ra*ik+lopa,i a*ala- s+a,+ kea*aan .an$ /er-+/+n$an *en$an $an$$+an 0+n$si *an s,r+k,+r ra*iks aki/a, proses pa,olo$ik .an$ *apa, 1en$enai sa,+ a,a+ le/i- ra*iks sara0 *en$an pola $an$$+an /ersi0a, *er1a,o1al
II. Etiologi
A*a /e/erapa -al .an$ 1en.e/a/kan ,er#a*in.a ra*ik+lopa,i2 *ian,aran.a .ai,+ proses ko1presi02 proses in0la11a,or.2 proses *e$enera,i0 ses+ai *en$an s,r+k,+r *an lokasi ,er#a*in.a proses
a Proses ko1presi0 Kelainan3kelainan .an$ /ersi0a, ko1presi0 se-in$$a 1en$aki/a,kan ra*ik+lopa,i a*ala- seper,i 4 -ernia n+5le+s p+lpos+s 6HNP7 a,a+ -erniasi *isk+s2 ,+1or 1e*+lla spinalis2 neoplas1a ,+lan$2 spon*ilolisis *an spon*iloli,-esis2 s,enosis spinal2 ,ra+1a,i5 *islokasi2 ko1presi0 0rak,+r2 s5oliosis *an spon*ili,is ,+/erk+losa2 5er8i5al spon*ilosis
/ Proses in0la11a,ori Kelainan3kelainan
in0la1a,ori
se-in$$a
1en$aki/a,kan
ra*ik+lopa,i
a*ala- seper,i 4 G+llain3Barre S.n*ro1e *an Herpes 9os,er
/ Proses *e$enera,i0 Kelainan3kelainan .an$ /ersi0a, *e$enera,i0 se-in$$a 1en$aki/a,kan ra*ik+lopa,i
a*ala- seper,i Dia/e,es Melli,+s
III. Tipe-tipe radikulopati
a Ra*ik+lopa,i l+1/ar Ra*ik+lopa,i l+1/ar 1er+pakan pro/le1a .an$ serin$ ,er#a*i .an$ *ise/a/kan ole- iri,asi a,a+ ko1presi ra*iks sara0 *aera- l+1/al Ia #+$a
(
serin$ *ise/+, s5ia,i5a Ge#ala .an$ ,er#a*i *apa, *ise/a/kan ole- /e/erapa se/a/ seper,i /+l$in$ *isk+s 6*isk /+l$es72 spinal s,enosis2 *e0or1i,as 8er,e/ra a,a+ -erniasi n+kle+s p+lpos+s Ra*ik+lopa,i *en$an kel+-an n.eri pin$$an$ /a:a- serin$ *i*apa,kan 6lo: /a5k pain7 / Ra*ik+lopa,i 5er8i5al Ra*ik+lopa,i 5er8i5al +1+n.a *ikenal *en$an ;pin5-e* ner8e< a,a+ sara0 ,er#epi, 1er+pakan ko1presi =a*a sa,+ a,a+ le/i- ra*i> sara0 +an$ -al+s pa*a le-er Ge#ala pa*a ra*ik+lopa,i 5er8i5al serin$n.a *ise/a/kan olespon*ilosis 5er8i5al 5 Ra*ik+lopa,i ,orakal Ra*ik+lopa,i ,orakal 1er+pakan /en,+k .an$ rela,i8e #aran$ *ari ko1presi sara0 pa*a p+n$$+n$ ,en$a- Daera- ini ,i*ak *i*esain +n,+k 1e1/en$kok se/an.ak l+1/al a,a+ 5er8i5al Hal ini 1en.e/a/kan area ,-oraks le/i #aran$ 1en.e/a/kan saki, pa*a spinal Na1+n2 kas+s .an$ serin$ .an$ *i,e1+kan pa*a /a$ian ini a*ala- n.eri pa*a in0eksi -erpes ?os,er
Pen$e,a-+an ana,o1i2 pe1eriksaan 0isik *ia$nos,ik *an pen$e,a-+an /er/a$ai pen.e/a/ +n,+k ra*ik+lopa,i san$a, *iperl+kan se-in$$a *ia$nosa *apa, *i,e$akkan se5ara *ini *an *apa, *i/erikan ,erapi .an$ ses+ai Ter*apa, & r+as ,+lan$ 8er,e/ra l+1/alis *an *ian,aran.a *i-+/+n$kan *en$an *is5+s in,er8er,e/ralis @er,e/ra l+1/alis ini 1eneri1a /e/an palin$ /esar *ari ,+lan$ /elakan$ se-in$$a s,r+k,+rn.a san$a, pa*a, Tiap 8er,e/ra l+1/alis ,er*iri *ari korp+s *an ark+s ne+ralis Korp+s 8er,e/ra l+1/al palin$ /esar *i/an*in$kan korp+s 8er,e/ra ,orakal *an 5er8ikal Ark+s ne+ralis ,er*iri *ari ( pe*ikel2 proses+s ,ran8ers+s2 0ase, ar,ik+laris 6proses+s ar,ik+laris7 s+perior *an in0erior2 la1ina ark+s 8er,e/ra *an
proses+s
spinos+s
Tiap
8er,e/ra
*i-+/+n$kan
*en$an
*isk+s
in,er8er,e/ralis2 /e/erapa li$a1en, spinalis *an proses+s ar,ik+laris0ase, ar,ik+larissen*i 0ase, Disk+s in,er8er,e/ralis /er0+n$si se/a$ai s-o5k a/sor/ers *an /ila ,er#a*i r+p,+re ke *ala1 kanalis spinalis *apa, 1enekan ra*iks3ra*iks sara0
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Pa*a 8er,e/ra l+1/alis .an$ le/i- a,as2 -+/+n$an an,ara proses+s ar,ik+laris ara-n.a 8er,i5al2 0ase, in0erior 1en$-a*ap ke la,eral *an 0ase, s+perior 1en$-a*ap ke 1e*ial Aki/a, s+s+nan ana,o1i .an$ *e1ikian 1en.e/a/kan ,er/a,asn.a ro,asi ke aksial .an$ 1e1+n$kinkan 0leksi a,a+ eks,ensi Pa*a *+a 8er,e/ra l+1/alis .an$ palin$ /a:a-2 -+/+n$an an,ara 0ase, ar,ik+laris ,erse/+, le/i- -ori?on,al se-in$$a 1o/ili,as ro,asi aksialn.a le/i /esar a,a+ l+as Hal ini 1en#elaskan serin$ ,er#a*in.a -erniasi *isk+s pa*a l+1/al % *an &
Ga1/ar ' Kol+1an @er,e/ra
Ga1/ar ( Ra*iks Sara0
%
Ga1/ar " Disk+s In,er8er,e/ralis po,on$an aksial
Ga1/ar % 4 Dis,ri/+si Der1a,o1al Pa*a Ba$ian A,as T+/+-
&
Ga1/ar & 4 Dis,ri/+si Der1a,o1al Pa*a Ba$ian Ba:a- T+/+-
I@ Pa,o0isiolo$i
Proses kompresif pada lumbal spinalis
Per$erakan an,ara 8er,e/ra L%L& *an L&S' le/i- lel+asa se-in$$a le/iserin$ ,er#a*i $an$$+an @er,er/ra l+1/alis 1e1iliki /e/an .an$ /esar +,,+k 1ena-an /a$ian a,as ,+/+- se-in$$a ,+lan$2 sen*i2 +5le+s) *an #arin$an l+nakn.a le/i- /esar *an k+a, Pa*a /an.ak kas+s2 proses *e$enerasi *i1+lai pa*a +sia le/i- a:al seper,i pa*a 1asa re1a#a *en$an *e$enerasi n+5le+s p+lpos+s .an$ *iik+,i pro,+si a,a+ eks,rasi *isk+s Se5ara klinis .an$ san$a, pen,in$ a*ala- ara- pro,+si ke pos,erior2 1e*ial a,a+ ke la,eral .an$ 1en.e/a/kan ,arikan 1ala- ro/ekan )+5le+s 0i/ros+s Pro,+si *isk+s pos,erola,eral *ike,a-+i se/a$ai pen.e/a/ ko1presi *ari ra*ik Bila proses ini /erlans+n$ se5ara pro$resi0 *apa, ,er/en,+k os,eo0i, Per1+kaan sen*i 1en#a*i 1al0or1asi *an ,+1/+- /erle/i-an2 ke1+*ian ,er#a*i pene/alan *ari li$a1en,+1 0la8+n Pa*a pasien *en$an kelainan kanal se1pi,2 proses ini ,er#a*i sepan#an$ 8er,e/ra l+1lais se-in$$a 1en.e/a/kan kanalis 1en#a*i ,i*ak /+la, *an 1e1/en,+k ,re0oil a>ial s-ape
)
Pa*a ,a-ap ini prosesn.a /er-+/+n$an *en$an proses pen+aan Pro,+si *isk+s *apa, 1en$enai se1+a #enis kela1in *an /er-+/+n$an *en$an ,ra+1a .an$ lal+ S,enosis kanalis 8er,e/ra l+1/alis serin$ 1en$enai laki3laki peker#a +sia ,+a Kelainan pa*a *isk+s 8er,e/ra l+1/alis -an.a 1er+pakan sala- sa,+ pen.e/a/ $an$$+an *ari 8er,e/ra l+1/alis Sen*i 0ase, 60a5e, #oin,72 n+5le+s *an o,o, #+$a *apa, 1en$ala1i per+/a-an *e$enera,i0 *en$an a,a+ ,anpa kelainan pa*a *isk+s
Pat!a"
#. $anifestasi Klinis Radikulopati
Se5ara +1+12 1ani0es,asi klinis ra*ik+lopa,i a*ala- se/a$ai /erik+, 4 ' Rasa n.eri /er+pa n.eri ,a#a1 .an$ 1en#alar *ari *aera- parasen,ral *eka, 8er,e/ra -in$$a ke ara- eks,re1i,as Rasa n.eri ini 1en$ik+,i pola *er1a,o1al N.eri /ersi0a, ,a#a1 *an *iper-e/a, ole- $erakan2 /a,+k2 1en$e*an2 a,a+ /ersin ( Pares,-esia .an$ 1en$ik+,i pola *er1a,o1al " Hilan$ a,a+ /erk+ran$n.a sensorik 6-ipes,-esia7 *i per1+kaan k+li, sepan#an$ *is,ri/+si *er1a,o1 ra*iks .an$ /ersan$k+,an % Kele1a-an o,o,3o,o, .an$ *ipersara0i ra*iks .an$ /ersan$k+,an & Re0les ,en*on pa*a *aera- .an$ *ipersara0i ra*iks .an$ /ersan$k+,an 1en+r+n a,a+ /a-kan 1en$-ilan$
Ge#ala ra*ik+lopa,i ,er$an,+n$ pa*a lokasi ra*iks sara0 .an$ ,erkena 6.ai,+ pa*a ser8ikal2 ,orakal2 a,a+ l+1/al7 N.eri ra*ik+lar .an$ /an$ki, aki/a, lesi iri,a,i0 *i ra*iks pos,erior ,in$ka, ser8ikal *ina1akan /rakial$ia2 karena n.erin.a *irasakan sepan#an$ len$an De1ikian #+$a n.eri ra*ik+lar .an$ *irasakan sepan#an$ ,+n$kai *ina1akan iskial$ia2 karena n.erin.a 1en#alar sepan#an$ per#alanan niskia*ik+s *an lan#+,ann.a ke peri0er Ra*ik+lopa,i se,in$$i se$1en ,orakal #aran$ ,er#a*i karena se$1en ini le/i- ri$i* *aripa*a se$1en ser8ikal 1a+p+n l+1/al Jika ,er#a*i ra*ik+lopa,i se,in$$i se$1en ,orakal2 1aka akan ,i1/+l n.eri pa*a len$an2 *a*a2 a/*o1en2 *an pan$$+l
Mani0es,asi klinis ra*ik+lopa,i pa*a *aera- ser8ikal an,ara lain 4 −
Le-er ,erasa kak+2 rasa ,i*ak n.a1an pa*a /a$ian 1e*ial skap+la
−
Ge#ala *iper/+r+k *en$an $erakan kepala *an le-er2 #+$a *en$an re$an$an pa*a len$an .an$ /ersan$k+,an Un,+k 1en$+ran$i $e#ala2 pen*eri,a serin$kali 1en$an$ka, *an 1e10leksikan len$ann.a *i /elakan$ kepala
−
Lesi pa*a C& *i,an*ai *en$an n.eri pa*a /a-+ *an *aera- ,rape?i+s2 /erk+ran$n.a sensorik ses+ai *en$an pola *er1a,o1al2 kele1a-an *an a,ro0i
o,o,
*el,oi*
Lesi
ini
*apa,
1en$aki/a,kan
/erk+ran$n.a
ke1a1p+an a/*+ksi *an eksoro,asi len$an
−
Lesi pa*a C) *i,an*ai *en$an n.eri pa*a ,rape?i+s2 +#+n$ /a-+2 *an 1en#alar -in$$a len$an a,as an,erior2 len$an /a:a- /a$ian ra*ial2 #ari ke3' *an /a$ian la,eral #ari ke3( Lesi ini 1en$aki/a,kan pares,-esia i/+ #ari2 1en+r+nn.a re0leks /iseps2 *iser,ai kele1a-an *an a,ro0i o,o, /iseps
−
Lesi pa*a C *i,an*ai *en$an n.eri pa*a /a-+2 area perk,oralis *an 1e*ial aksila2 pos,erola,eral len$an a,as2 sik+2 *orsal len$an /a:a-2 #ari ke3( *an " a,a+ sel+r+- #ari Lesi ini *apa, 1en$aki/a,kan pares,-esia #ari ke3(2" #+$a #ari per,a1a2 a,ro0i *an kele1a-an o,o, ,riseps2 eks,ensor ,an$an2 *an pek,oralis
−
Lesi pa*a C *i,an*ai *en$an n.eri sepan#an$ /a$ian 1e*ial len$an /a:a- Lesi ini akan 1en$$an$$+ 0+n$si o,o,3o,o, in,rinsik ,an$an *an sensasi #ari ke3% *an & 6seper,i pa*a $an$$+an n+lnaris7
Ga1/ar '( Pen#alaran n.eri pa*a ra*ik+lopa,i ser8ikal
Mani0es,asi klinis ra*ik+lopa,i pa*a *aera- l+1/al an,ara lain 4 −
Rasa n.eri pa*a *aera- sakroiliaka2 1en#alar ke /okon$2 pa-a2 -in$$a ke /e,is2 *an kaki N.eri *apa, *i,i1/+lkan *en$an Valsava maneuvers 6seper,i 4 /a,+k2 /ersin2 a,a+ 1en$e*an saa, *e0ekasi7
−
Pa*a r+p,+r *isk+s in,er8er,e/ra2 n.eri *irasakan le/i- /era, /ila pen*eri,a se*an$ *+*+k a,a+ akan /er*iri Ke,ika *+*+k2 pen*eri,a akan 1en#a$a l+,+,n.a *ala1 kea*aan 0leksi *an 1en+1p+kan /era, /a*ann.a pa*a /okon$ .an$ /erla:anan Ke,ika akan /er*iri2 pen*eri,a 1enopan$ *irin.a pa*a sisi .an$ se-a,2 1ele,akkan sa,+ ,an$an *i p+n$$+n$2 1enek+k ,+n$kai .an$ ,erkena 6 Minor’s sign7
N.eri 1ere*a ke,ika pasien /er/arin$ U1+1n.a pen*eri,a 1erasa n.a1an *en$an /er/arin$ ,elen,an$ *iser,ai 0leksi sen*i 5o>ae *an l+,+,2 *an /a-+ *isan$$a *en$an /an,al +n,+k 1en$+ran$i lor*osis l+1/al Pa*a ,+1or in,raspinal2 n.eri ,i*ak /erk+ran$ a,a+ /a-kan 1e1/+r+k ke,ika /er/arin$ −
Gan$$+an pos,+r a,a+ k+r8a,+ra 8er,e/ra Pa*a pe1eriksaan *apa, *i,e1+kan /erk+ran$n.a
lor*osis 8er,e/ra l+1/al karena spas1e
in8ol+n,er o,o,3o,o, p+n$$+n$ Serin$ *i,e1+i skoliosis l+1/al2 *an 1+n$kin #+$a ,er#a*i skoliosis ,orakal se/a$ai ko1pensasi U1+1n.a ,+/+- akan 5on*on$ 1en#a+-i area .an$ saki,2 *an pan$$+l akan 1irin$2 se-in$$a sen*i 5o>ae akan ,eran$ka, Bisa sa#a ,+/+- pen*eri,a akan /+n$k+k ke *epan *an ke ara- .an$ saki, +n,+k 1en$-in*ari stretching pa*a sara0 .an$ /ersan$k+,an Jika iskial$ia san$a, /era,2 pen*eri,a akan 1en$-in*ari eks,ensi sen*i l+,+,2 *an /er#alan *en$an /er,+1p+ pa*a #ari kaki 6karena *orsi0leksi kaki 1en.e/a/kan stretching pa*a sara02 se-in$$a 1e1per/+r+k n.eri7 Pen*eri,a /+n$k+k ke *epan2 /er#alan *en$an lan$ka- ke5il *an se1i0leksi sen*i l+,+, *ise/+, Neri’s sign −
Ke,ika pasien /er*iri2 *apa, *i,e1+kan gluteal fold .an$ 1en$$an,+n$ *an ,a1pak lipa,an k+li, ,a1/a-an karena o,o, $l+,e+s .an$ le1a- Hal ini 1er+pakan /+k,i ke,erli/a,an ra*iks S'
−
Dapa, *i,e1+kan n.eri ,ekan pa*a sciatic notch *an sepan#an$ niskia*ik+s
−
Pa*a ko1presi ra*iks spinal .an$ /era,2 *apa, *i,e1+kan $an$$+an sensasi2 pares,-esia2 kele1a-an o,o,2 *an $an$$+an re0leks ,en*on Fasik+lasi #aran$ ,er#a*i
−
Hernia N+5le+s P+lpos+s 6HNP7 /iasan.a ,erle,ak *i pos,erola,eral *an 1en$aki/a,kan $e#ala .an$ +nila,eral Na1+n /ila le,ak -ernia a$ak /esar *an sen,ral2 *apa, 1en.e/a/kan $e#ala pa*a ke*+a sisi .an$ 1+n$kin *apa, *iser,ai $an$$+an /erke1i- *an /+an$ air /esar
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Ga1/ar '" Pen#alaran n.eri pa*a ra*ik+lopa,i l+1/al
Ta/el ' Common Root Syndromes of Intervertebral Disc Disease L"3% Disc space L% Root affected Muscles Quadricep affected s
Area of pain and sensory loss Reflex affected Straight leg raising
&nterior thigh! medial shin (nee )er*
L%3&
L&3S'
C%3&
C)3
C3T'
L&
S'
C&
C
C
eroneals! #luteus anterior ma"imus! tibial! gastrocne e"tensor mius! hallucis plantar longus fle"or of toes #reat toe! 'ateral dorsum of foot! small foot toe
osterior &n*le )er* tibial Many not &ggravate &ggravate increase s root pain s root pain pain
Deltoid! biceps
$riceps! Intrinsic %rist hand e"rensors muscles
Shoulder! anterior arm! radial forearm +iceps
$humb! middle fingers
3
$riceps 3
Inde"! fourth fifth finger $riceps 3
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Pemeriksaan %isik
Se/el+1 1elak+kan pe1eriksaan 0isik2 a*ala- pen,in$ +n,+k 1elak+kan ana1nesa ,erle/i- *a-+l+ Hal ini *ilak+kan +n,+k 1en$e,a-+i -+/+n$an *en$an ,ra+1a a,a+ in0eksi *an rek+rensi Har+s *i,an.akan karak,er n.eri2 *is,ri/+si *an pen#alarann.a2 a*an.a pares,-esia *an $an$$+an s+/#ek,i0 lainn.a2 a*an.a $an$$+an 1o,orik 6seper,i kele1a-an *an a,ro0i o,o,7 J+$a perl+ *ike,a-+i $e#ala lainn.a seper,i $an$$+an pen5ernaan *an /erke1i-2 anes,esia rek,al$eni,al Pe1eriksaan
0isik
.an$
len$kap
a*ala-
pen,in$
Pen,in$
+n,+k
1e1per-a,ikan a/nor1ali,as pos,+r2 *e0or1i,as2 n.eri ,ekan2 *an spas1e o,o, Pa*a pe1eriksaan ne+rolo$is -ar+s *iper-a,ikan 4
Gan$$+an sensorik 6-ipes,-esia a,a+ -iperes,-esia7 Perl+ *i/e*akan $an$$+an sara0 peri0er a,a+ se$1en,al
Gan$$+an 1o,orik 6pe1eriksaan kek+a,an o,o,2 a,ro0i2 0asik+lasi2 spas1e o,o,7
Per+/a-an re0leks
Pe1eriksaan pan$$+l *an rek,+1 perl+ *ilak+kan +n,+k 1en.in$kirkan a*an.a neoplas1a *an in0eksi *i l+ar 8er,e/ra Pa*a pe1eriksaan ra*ik+lopa,i ser8ikal2 an,ara lain akan *i*apa,kan4 ' Ter/a,asn.a ;range of motion< le-er ( N.eri akan /er,a1/a- /era, *en$an per$erakan 6,er+,a1a -ipereks,ensi7
#I. Penatalaksanaan Radikulopati
' In0or1asi *an e*+kasi ( Far1ako,erapi a
Ak+, 4 ase,a1ino0en2 NSAID2 1+s5le rela>an,2 opioi* 6n.eri /era,72 in#eksi epi*+ral
/
Kronik 4 an,i*epresan ,risiklik 6a1i,rip,ilin72 opioi* 6kala+ san$a, *iperl+kan7
" Terapi non0ar1akolo$ik a
Ak+, 4 i1o/ilisasi 6la1an.a ,er$an,+n$ kas+s72 pen$a,+ran /era, /a*an2 posisi ,+/+- *an ak,i8i,as2 1o*ali,as ,er1al
'(
6,erapi panas *an *in$in72 1asase2 ,raksi 6,er$an,+n$ kas+s72 ala, /an,+ 6an,ara lain korse,2 ,on$ka,7 /
Kronik
4
,erapi
psikolo$ik2
1o*+lasi
n.eri
6ak+p+nk,+r2 1o*ali,as ,er1al72 la,i-an kon*isi o,o,2 re-a/ili,asi 8okasional2 pen$a,+ran /era, /a*an2 posisi ,+/+- *an ak,i8i,as % In8asi0 non/e*a
Blok sara0 *en$an anes,e,ik lokal
In#eksi s,eroi* 61e,ilpre*nisolon7 pa*a epi*+ral +n,+k 1en$+ran$i pe1/en$kakan e*e1a,o+s se-in$$a 1en+r+nkan ko1presi pa*a ra*iks sara0
& Be*aIn*ikasi operasi pa*a HNP 4
Skia,ika *en$an ,erapi konser8a,i0 sela1a le/i- *ari % 1in$$+ 4 n.eri /era, intractable 1ene,ap pro$resi0
De0isi, ne+rolo$ik 1e1/+r+k
Sin*ro1a ka+*a
S,enosis kanal 4 se,ela- ,erapi konser8a,i0 ,i*ak /er-asil
Ter/+k,i
a*an.a
ko1presi
ra*iks
/er*asarkan
pe1eriksaan
ne+ro0isiolo$ik *an ra*iolo$ik
#II Pemeriksaan Penun&ang Radikulopati
Ra*ik+lopa,i *apa, *i*ia$nosa *ari 1eni0es,asi klinis .an$ k-as2 seper,i rasa n.eri2 /aal2 a,a+ pares,-esia .an$ 1en$ik+,i pola *er1a,o1al Na1+n *e1ikian $e#ala3$e#ala ,erse/+, *apa, *ise/a/kan ole- /an.ak -al2 se-in$$a +n,+k 1enen,+kan pena,alaksanaan ra*ik+lopa,i2 *iperl+kan /e/erapa pe1eriksaan pen+n#an$2 an,ara lain 4 a
Ron,$en T+#+an +,a1a 0o,o polos Roen,$en a*ala- +n,+k 1en*e,eksi a*an.a kelainan s,r+k,+ral Serin$kali kelainan .an$ *i,e1+kan pa*a 0o,o roen,$en pen*eri,a ra*ik+lopa,i #+$a *apa, *i,e1+kan pa*a in*i8i*+ lain .an$ ,i*ak 1e1iliki kel+-an apap+n
/
MRICT Scan
'"
MRI
1er+pakan
1en*e,eksi
pe1eriksaan
kelainan
*isk+s
pen+n#an$
in,er8er,e/ra
.an$
+,a1a
+n,+k
MRI
selain
*apa,
1en$i*en,i0ikasi ko1presi 1e*+la spinalis *an ra*iks sara02 #+$a *apa, *i$+nakan +n,+k 1en$e,a-+i /era,n.a per+/a-an *e$enera,i0 pa*a *isk+s in,er8er,e/ra Di/an*in$kan *en$an CT Scan2 MRI 1e1iliki ke+n$$+lan2 .ai,+ a*an.a po,on$an sa$i,al2 *an *apa, 1e1/erikan $a1/aran -+/+n$an *isk+s in,er8er,e/ra *an ra*iks sara0 .an$ #elas se-in$$a MRI
1er+pakan
prose*+r skrinin$ .an$
i*eal
+n,+k
1en.in$kirkan *ia$nosa /an*in$ $an$$+an s,r+k,+ral pa*a 1e*+la spinalis *an ra*iks sara0 CT Scan *apa, 1e1/erikan $a1/aran s,r+k,+r ana,o1i ,+lan$ 8er,e/ra *en$an /aik2 *an 1e1/erikan $a1/aran .an$ /a$+s +n,+k -erniasi *isk+s in,er8er,e/ra Na1+n *e1ikian sensi,i8i,as CT Scan ,anpa 1.elo$rap-. *ala1 1en*e,eksi -erniasi 1asi- k+ran$ /ila *i/an*in$kan *en$an MRI 5
M.elo$ra0i Pe1eriksaan ini 1e1/erikan $a1/aran ana,o1ik .an$ *e,ail2 ,er+,a1a ele1en osse+s 8er,e/ra M.elo$ra0i 1er+pakan proses .an$ in8asi0 karena 1eli/a,kan pene,rasi pa*a r+an$ s+/ara5-noi* Se5ara +1+1 1.elo$ra1 *ilak+kan se/a$ai ,es, preopera,i02 serin$kali *ilak+kan /ersa1a *en$an CT Scan
*
Nerve Concuction Study 6NCS72 *an ,lectromyography 6EMG7 NCS *an EMG san$a, 1e1/an,+ +n,+k 1e1/e*akan asal n.eri a,a+ +n,+k 1enen,+kan ke,erli/a,an sara02 apaka- *ari ra*iks2 pleks+s sara02 a,a+ sara0 ,+n$$al Selain i,+ pe1eriksaan ini #+$a 1e1/an,+ 1enen,+kan lokasi ko1presi ra*iks sara0 Na1+n /ila *ia$nosis ra*ik+lopa,i s+*a- pas,i se5ara pe1eriksaan klinis2 1aka pe1eriksaan elek,ro0isiolo$is ,i*ak *ian#+rkan
e
La/ora,ori+1 Pe1eriksaan *ara- peri0er len$kap2 la#+ en*ap *ara-2 0ak,or re1a,oi*2 0os0a,ase alkaliasa12 kalsi+1
'%
Urin analisis2 /er$+na +n,+k pen.aki, nonspesi0ik seper,i in0eksi
#III. Diagmosa Kepera!atan '. N.eri .an$ /er-+/+n$an *en$an 1asala- 1+sk+loskele,al (. Gan$$+an 1o/ili,as 0isik /er-+/+n$an *en$an n.eri2 spas1e o,o,2 *an
/erk+ran$n.a kelen,+ran ). K+ran$ pen$e,a-+an .an$ /er-+/+n$an *en$an ,e-nik 1ekanika ,+/+-
1elin*+n$i p+n$$+n$ *. K+ran$
pen$e,a-+an
/*
k+ran$n.a
in0or1asi
1en$enai kon*isi2
pro$nosis
I+. Ren,ana Kepera!atan
' N.eri /* ko1presi sara02 spas1e o,o, Ka#i kel+-an n.eri2 lokasi2 la1an.a seran$an2 0ak,or pen5e,+s .an$ 1e1per/era, Te,apkan skala ! '! Per,a-ankan ,ira- /arin$2 posisi se1i 0o:ler *en$an ,+lan$ spinal2 pin$$an$ *an l+,+, *ala1 kea*aan 0leksi2 posisi ,elen,an$ •
G+nakan lo$roll 6papan7 sela1a 1elak+kan per+/a-an posisi
•
Ban,+ pe1asan$an /ra5e korse,
•
Ba,asi ak,i0i,as sela1a 0ase ak+, ses+ai *en$an ke/+,+-an
•
A#arkan ,eknik relaksasi
•
Kola/orasi 4 anal$e,ik2 ,raksi2 0isio,erapi
( Gan$$+an 1o/ili,as 0isik /* n.eri2 spas1e o,o,2 ,erapi res,rik,i0 *an ker+sakan ne+ro1+sk+l+s •
Berikan /an,+ pasien +n,+k 1elak+kan la,i-an ren,an$ $erak pasi0 *an ak,i0
•
Ban,+ pasien *ala1 1elak+kan ak,i8i,as a1/+lasi pro$resi0
'&
•
Berikan pera:a,an k+li, *en$an /aik2 1asase ,i,ik .an$ ,er,ekan se,elare-ap per+/a-an posisi Periksa kea*aan k+li, *i/a:a- /ra5e *en$an perio*e :ak,+ ,er,en,+
•
Ca,a, respon e1osi perilak+ pa*a i11o/ilisasi
•
De1ons,rasikan pen$$+naan ala, penolon$ seper,i ,on$ka,
•
Kola/orasi 4 anal$e,ik
" Ansie,as /* ,i*ak e0ek,i0n.a kopin$ in*i8i*+al
•
Ka#i ,in$ka, ansie,as pasien
•
Berikan in0or1asi .an$ ak+ra,
•
Berikan kese1pa,an pasien +n,+k 1en$+n$kapkan 1asala- seper,i ke1+n$kinan paralisis2 pen$ar+- ,er-a*ap 0+n$si seks+al2 per+/a-an peran *an ,an$$+n$ #a:a/
•
Ka#i a*an.a 1asala- sek+n*er .an$ 1+n$kin 1erin,an$i kein$inan +n,+k se1/+- *an 1+n$kin 1en$-alan$i proses pen.e1/+-ann.a
•
Li/a,kan kel+ar$a
% K+ran$ pen$e,a-+an /* k+ran$n.a in0or1asi 1en$enai kon*isi2 pro$nosis
•
Jelaskan ke1/ali proses pen.aki, *an pro$nosis *an pe1/a,asan ke$ia,an
•
Berikan in0or1asi 1en$enai 1ekanika ,+/+- sen*iri +n,+k /er*iri2 1en$an$ka, *an 1en$$+nakan sepa,+ pen.okon$
•
Disk+sikan 1en$enai pen$o/a,an *an e0ek sa1pin$n.a
•
An#+rkan +n,+k 1en$$+nakan papan 1a,ras .an$ k+a,2 /an,al ke5il .an$ a$ak *a,ar *i/a:a- le-er2 ,i*+r 1irin$ *en$an l+,+, *i0leksikan2 -in*ari posisi ,el+n$k+p
•
Hin*ari pe1akaian pe1anas *ala1 :ak,+ .an$ la1a
•
Berikan in0or1asi 1en$enai ,an*a3,an*a .an$ perl+ *iper-a,ikan seper,i n.eri ,+s+k2 ke-ilan$an sensasi ke1a1p+an +n,+k /er#alan
')
DAFTAR PUSTAKA ' Bo8i1 G2 S5-ra*er H2 San* T Ne5k Pain in ,-e $eneral pop+la,ion Spine '% '4 '"!3'"! ( Si*-ar,a P Saki, Ne+ro1+sk+loskele,al Jakar,a 4 PT Dian Rak.a, '%p )3 " Bas#ir+**in Clini5al 1ana$e1en, o0 ne5k pain Ne+rona (!!( ' 4 '"3' % S1+l.an I De$enera,i8e *is5 an* o,-er ne+ral lesion In 4 Tollison CD2 Sa,,er,-:ai,e JR 6e*7 Pain0+l 5er8i5al ,ra+1a USA 4 illia1 an* ilkins '(p ")( 3 & Deen G Ba5k an* Ne5k Pain In 4 Sir8en JI2 Mala1+, BL 6 e*7 Clini5al Ne+rolo$. o0 ,-e ol*er a*+l,' s, e* Ne: .ork Lippin5o,, illia1s ilkins (!!( p ''3 ) D+n*a I H+/+n$an an,ara $a1/aran klinis ra*ik+lopa,i ser8ikalis *en$an 0o,o polos ser8ikal *an EMG *i RSUPN Cip,o Man$+nk+s+1o Tesis PPDS Ne+rolo$i FKUI (!!' Ellen/er$ MR2 Hone, JC2 Treanor J Cer8i5al Ra*i5+lopa,-. Ar5- P-.s Me* Re-a/il '% & 4 "%( &( Malan$a GA Cer8i5al Ra*i5+lopa,-. A8aila/le a, -,,p:::e1e*i5ine5o1
'
