CURICULUM VITAE

PERSONAL
Name: Sabri Ibrahim
Place/ date of bird: North Aceh/ June 05, 1973
Nationality: Indonesia
Sex: Male
Marital status: Married, one son & one daughter
Religion: Islam

PHONE AND ADDRESS

Phone number: 081361724415
Address: jl asrama komplek bumi asri blok B 201, Medan, sumatera utara
Email: sabriibrahimnc@gmai.com

EDUCATION
2014-2014: Spinal surgery fellowship at Lilavati Hospital and Research Center in
Mumbai, India
2013-2013: General neurosurgery fellowship at Siloam Hospital karawaci,
Tangerang, Indonesia
2009-2013: Resident of neurosurgery, in universiry of sumatera utara, Medan
2009-2011: Magister of neurosurgery, in universiry of sumatera utara, Medan
1995-2002: faculty of medicine, in universiry of sumatera utara, Medan
1992-1994: senior high school in SMU Matang Glumpang Dua, NAD
1990-1992: Secondary school in SLTP Gandapura, NAD
1986-1990: Elementary school in SDN Cotkruet, NAD

COURSE
2017-2017: Naton Academy Instructional Spinal Courses, DCN Orthopaedic
Hospital, Beijing, Cina
2016-2016: The 6th INERF ASEAN Skull Base Hands On Dissection Workshop, at
Chulalongkorn University, Bangkok, Thailand
 EPYDEMIOLOGY

• Approximately 10% of patients with

extrapulmonary tuberculosis have skeletal
involvement.
• Spinal Tuberculosis represents about 50% of
all cases of skeletal tuberculosis.
• Mycobacterium tuberculosis infection is the
most common opportunistic infection
associated with HIV
Esteves S, Catarino I, Lopes D and Sousa C, Spinal Tuberculosis: Rethinking an Old Disease, Esteves, et al., J Spine 2017, 6:1
 EPYDEMIOLOGY

• In 2015, 10.4 million new cases of TB

worldwide were detected.
• 60% of the cases were diagnosed in 6
countries: India, Indonesia, China, Nigeria,
Pakistan and South Africa.
• 400 000 had HIV infection

Esteves S, Catarino I, Lopes D and Sousa C, Spinal Tuberculosis: Rethinking an Old Disease, Esteves, et al., J Spine 2017, 6:1
 EPYDEMIOLOGY

• The lower thoracic region is most frequently

affected (40% to 50% of the cases),
• Followed by the lumbar spine (35% to 45%)
• And the cervical spine (10%)

Esteves S, Catarino I, Lopes D and Sousa C, Spinal Tuberculosis: Rethinking an Old Disease, Esteves, et al., J Spine 2017, 6:1
 CLINICAL FEATURES

• Pain, neurological deficit, cold abscess, and

kyphotic deformity are the characteristic features
of ST.
• Constitutional symptoms of;
– Malaise,
– Fatigue,
– Loss of weight and appetite,
– Evening rise in temperature and night sweats may also
be present but are more typical of pulmonary TB
Esteves S, Catarino I, Lopes D and Sousa C, Spinal Tuberculosis: Rethinking an Old Disease, Esteves, et al., J Spine 2017, 6:1
 IMAGING
CXR
• 66% will have an abnormal CXR
• Should be ordered for any patients in which TB is a
possibility

Spine radiographs
– Destruction, compression, and development of severe
kyphosis
– Retropulsion
– Subluxation
– Lateral translation

https://www.orthobullets.com/spine/2017/spinal-tuberculosis
 IMAGING
• CT
Types of destruction
• Fragmentary
• Osteolytic
• Subperiostealsclerotic

https://www.orthobullets.com/spine/2017/spinal-tuberculosis
 IMAGING
MRI with gadolinium contrast
• Low signal on T1-weighted images,
• Bright signal on T2-weighted images
• Presence of a septate pre-/ paravertebral / intra-osseous
smooth walled abscess end-plate disruption
• Paravertebral soft tissue shadow
• High signal intensity of the disc on the T2-weighted image
• Spinal cord;
– edema
– myelomalacia
– atrophy

https://www.orthobullets.com/spine/2017/spinal-tuberculosis
 LABORATORY FINDING
CBC
• Relative lymphocytosis
• Low hemoglobin
ESR
• Usually elevated but may be normal in up to 25%
PPD (purified protein derivative of tuberculin)
• Positive in ~ 80%
• CT guided biopsy with cultures and staining effective at
obtaining diagnosis
• PCR allows for faster identification (95% sensitivity and 93%
accuracy)
• Culture positive in 83%
https://www.orthobullets.com/spine/2017/spinal-tuberculosis
 TREATMENT
Nonoperative
• Isoniazid, rifampin, and pyrazanamide therapy
• Indications
– drugs are the mainstay of treatment in most cases
• Technique
– Treated with isoniazid, rifampin, and pyrazanamide for
9 to 18 months
– Ethambutol and Streptomycin added for part of
treatment
Spinal orthosis; indications may be used for pain
control and prevention of deformity
https://www.orthobullets.com/spine/2017/spinal-tuberculosis
 SURGICAL INDICATIONS
• Neurologic deficit; acute neurological
deterioration, para/tetraparesi and
para/tetraplegia
• Spinal deformity with instability or pain
• No respon to medical therapy, continuing
progession of kyphosis/instability
• Large paraspinal abscess
• Nondiagnostic percutaneous needle biosy
sample
Hildago J A & Brusch J L, Pott Disease Treatment & Management Updated: Jun 03, 2016
 GOALS OF SURGERY

• Relief of neural compression.

• Maintainance of spinal stability.
• Obtaining tissue for biopsy
• Thorough debridement.

Dasari R, Prasad K S, Thota P, Raman B. V. S. Institutional experience of tuberculosis of craniovertebral junction,

Int J Res Med Sci. 2017 Apr;5(4):1294-1299
ADVANTAGE OF SURGICAL TREATMENT

1. Less progressive kyphosis

2. Earlier healing
3. Decreased sinus formation
4. In patients with neurologic deficits,
early debridement and
decompression led to improved
neurologic recovery
https://www.orthobullets.com/spine/2027/spinal-tuberculosis
Pasien
Normal
h
• Boy 18yo
• Neck pain
• Tetrapasresis; MS 3/3
• CXR: normal
• M, 31 YO
• PARAPARESIS
• MS 5/3
• BACK&RADICULAR
PAIN
• CXR ; N