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  • Tata Laksana Nyeri Pinggang Bawah: Dr. Hardhi Pranata, SP.S, Mars

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    This document discusses low back pain (LBP), including its causes, diagnosis, and treatment. It begins by describing the anatomy of the lumbar spine and canalis vertebralis where the medulla spinalis is located. It then lists the most common causes of mechanical LBP as lumbar strain, sprain, degenerative disk disease, herniated disks, spinal stenosis, and fractures. Rare non-mechanical causes include infections, tumors, and inflammatory diseases. Diagnosis involves physical exams like Lasegue's sign and imaging like MRI. Differential diagnosis considers mechanical spinal issues, non-mechanical spinal conditions, and visceral diseases. Treatment focuses on medications like NSAIDs, muscle relaxants, opioids

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    Low Back Pain

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    This document discusses low back pain (LBP), including its causes, diagnosis, and treatment. It begins by describing the anatomy of the lumbar spine and canalis vertebralis where the medulla spinalis is located. It then lists the most common causes of mechanical LBP as lumbar strain, sprain, degenerative disk disease, herniated disks, spinal stenosis, and fractures. Rare non-mechanical causes include infections, tumors, and inflammatory diseases. Diagnosis involves physical exams like Lasegue's sign and imaging like MRI. Differential diagnosis considers mechanical spinal issues, non-mechanical spinal conditions, and visceral diseases. Treatment focuses on medications like NSAIDs, muscle relaxants, opioids

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    11 views57 pages

    Tata Laksana Nyeri Pinggang Bawah: Dr. Hardhi Pranata, SP.S, Mars

    Uploaded by

    soleh
    This document discusses low back pain (LBP), including its causes, diagnosis, and treatment. It begins by describing the anatomy of the lumbar spine and canalis vertebralis where the medulla spinalis is located. It then lists the most common causes of mechanical LBP as lumbar strain, sprain, degenerative disk disease, herniated disks, spinal stenosis, and fractures. Rare non-mechanical causes include infections, tumors, and inflammatory diseases. Diagnosis involves physical exams like Lasegue's sign and imaging like MRI. Differential diagnosis considers mechanical spinal issues, non-mechanical spinal conditions, and visceral diseases. Treatment focuses on medications like NSAIDs, muscle relaxants, opioids

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    of 57

    TATA LAKSANA

    NYERI PINGGANG BAWAH

    dr. Hardhi Pranata, Sp.S,


    MARS

    11 Maret 2018
    Corpus vertebralis
    dan discus
    intervertebralis

    Pedikel, lamina, canalis


    vertebralis serta
    processus spinosus dan
    transversus

    Canalis vertebralis, terdapat medulla spinalis yang membujur ke bawah sampai L2

    cervical thoracal
    Chorda spinalis
    DIFFERENTIAL DIAGNOSIS OF LOW
    BACK PAIN
    MECHANICAL LOW NONMECHANICAL SPINAL
    BACK OR LEG PAIN CONDITIONS (ABOUT 1%) VISCERAL DISEASE (2%)
    (97%)
    Lumbar strain, sprain (70%) Neoplasia (0,7%) Disease of pelvic organs
    Degenerative process of disk and facets Multiple myeloma Prostatitis
    usually age-related (10%) Metastatic carcinoma Endometriosis
    Herniated disk (4%) Lymphoma and leukemia Chronic pelvic inflammatory
    Spinal stenosis (3%) Spinal cord tumors disease
    Osteoporotic compression fracture (4%) Retroperitoneal tumors Renal disease
    Spondy lolisthesis (2%) Infection (0,01%) Nephrolithiasis
    Traumatic fracture (<1%) Osteomyelitis Pyelonephritis
    Congenital desease (<1%) Septic diskitis Perinephric abcess
    Severe kyphosis Paraspinous abcess Aortic aneurysm
    Severe scoliosis Epidural abscess Gastrointestinal disease
    Transitional vertebrae Shingles Pancreatitis
    Spondylolysis Inflammatory arthritis (often associated Cholecystitis
    Internal disk disruption or diskogenic low with HLA-B27) (0,3%) Penetrating uker
    back pain Ankylosing spondylitis
    Presumed instability Psoriatic spondylitis
    Reiter’s syndrome
    Inflammatory bowel disease
    Scheuermann’s disease (osteochondrosis)
    Paget’s disease of bone
    Pathoanatomical
    Condition of the
    Lumbar Spine
    (cytokines
    Osteophyte Formation
    sensory
    impairment
    related to level of
    spinal cord injury
    2. Sindroma Cauda Equina

    Thoracal

    Cauda
    Patella L3-L4, L4–L5

    Pemeriksaan
    Lasseque
    Lasseque menyilang
    Valsava
    Patrick
    Manuver Contra-
    Patrick
    Radiologis Lumbosakral:

    MRI sangat sensitive untuk diagnosis HNP


    EMG (Electromiografi) dapat membedakan kelainan pada
    Radiks (HNP) atau kelaianan saraf tepi
    Laboratorium: Darah lengkap, LED, CRP, IGRA, Urin
    lengkap bila ada kecurigaan infeksi
    Kegawat Daruratan Nyeri
    Pinggang

    Kegawat daruratan nyeri pinggang meliputi:


    Cauda Equina
    Cauda Equina
    Cauda Equina:

    Penurunan berat badan


    YELLOW FLAGS
    Keadaan yang membuat LBP lambat sembuh
    - Postur tidur, duduk, serta aktivitas yang salah
    - Faktor Psikologis: Lingkungan, pekerjaan, keluarga
    - Diagnosis dan terapi yang belum tepat

    Mengemudi

    Bekerja

    Mengangkat Barang

    Bekerja

    Bekerj
    a
    Yellow flags adalah faktor yang menjadi petunjuk
    bagi LBP menjadi kronis
    TATA
    TATALAKSANA
    LAKSANA
    OBAT-OBATAN

    (1) NON-STEROID ANTI INFLAMMATOIR DRUG (NSAID)


    A. NON-SELECTIVE COX INHIBITORS
    Salycilates, Ibuprofen, Indomethacin, Diclofenac, Piroxicam, Mefenamic acid
    B. SELECTIVE COX-2 INHIBITORS:
    Celecoxib, Etoricoxib

    (2) ANALGESIC PARACETAMOL


    (3) MUSCLE RELAXANT: Eperison (Myonal), Tizanidine (Sirdalud)
    (4) GOLONGAN OPIOID: Tramadol
    (5) OBAT NEUROPATI: Pregabalin, Gabapentin
    Mild
    TATA LAKSANA
    Regina, Bambang S. NYERI PINGGANG BAWAH (LOW BACK PAIN). Kepaniteraan
    Klinik Bagian/ SMF Neurologi RSUD
    For Your Attention

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