Trauma Medula Spinalis

Dr, Muhamad Yunus, SpBS

Bedah Saraf FK Malahayati

 Tulang Belakang Normal
• 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:
1. Anamnesis
2. Pemeriksaan Fisik
– Umum
– Pemeriksaan neurologis
3. Radiologi
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
Lesi spinal cord :

Trauma

Komplit Inkomplit
1. Anterior cord syndrome
2. Central cord syndrome
3. Brown-Sequard syndrome
4. Posterior cord syndrome
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
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 (-)
• Radiologi
– Pemeriksaan X-ray
– CT-Scan
– MRI
• Foto X-Ray
Cervical Lateral
AML: anterior
Marginal Line

PML: Posterior PSL: Posterior

Marginal Line Spinous Line

SLL: Spino
Laminar Line
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