Infeksi Vertebra Dept Ilmu Bedah Orthopaedi Dan Traumatologi

7/22/2019 Infeksi Vertebra Dept Ilmu Bedah Orthopaedi Dan Traumatologi

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MAKALAHINFEKSI VERTEBRA

DISUSUN OLEH :

EDWARD 090100079

FELIX LEO 090100121

HEMA THIYAGU 090100408THEVAGIH EHAMBARAM 090100421

CHRISTY DYMPHNA 090100425

PEMBIMBING:dr. PRANAJAYA DHARMA KADAR, SpOT(K)

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Anatomi

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Definisi Infeksi Kolom vertebral (tulang), diskus

intervertebralis, kantung dural (meliputi sekitarsumsum tulang belakang) atau ruang di sekitarsumsum tulang belakang. Infeksi dapat disebabkanoleh bakteri atau organisme jamur.

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Etiologi Septik arthritis, sinusitis, subakut endokarditis

bakteri, dan pernapasan, oral, atau infeksigastrointestinal.

Sekitar 30-70% pasien dengan osteomielitis vertebraltidak memiliki infeksi jelas sebelumnya.

Selain itu etiologi yang menyangkut juga adalah

mengalami bedah waktu lama, instrumentasi danoperasi kembali.Kebanyakan infeksi pasca operasiterjadi antara tiga hari dan tiga bulan setelah saatoperasi.

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Epidemiologi Osteomielitis vertebral dianggap jarang, dengan kejadian 1

kasus per 100,000-250,000 penduduk per tahun.

Osteomielitis memiliki kecenderungan untuk laki-laki.

Di negara-negara kurang berkembang, osteomielitismenular lebih umum.

Abses Epidural dapat terjadi pada semua usia, tetapi yangpaling umum pada orang usia 50 dan lebih tua.

Beberapa studi menunjukkan bahwa kejadian infeksitulang belakang kini meningkat. Spike ini mungkinberhubungan dengan peningkatan penggunaan perangkatpembuluh darah dan bentuk lain dari instrumentasi danpeningkatan penyalahgunaan obat intravena.

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DIAGNOSIS Clinically manifested as:

Back pain (local, insidious onset, gradually progressingand increases in intensity, aggravated by movement)

Mild tenderness over the spinous process of the involvedvertebra, minimal paravertebral muscles spasm,

decreased range of motion Fever (only about half of patients)

Neurologic deficits

Sensoric examination sensory level, posterior columnfunction, normal and abnormal reflexes, examination ofrectal tone and perianal sensation

Motoric examination muscle strength and weaknessgraded ranging from strenght of 5/5, considered normal,to a strength of 0/5, or paralysis

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DIAGNOSIS The process of diagnosis a spinal infection begins with

a plain radiograph (usually nrmal in the first 2-4weeks)

Abnormalities found:

Narrow disk space and destruction of the endplatesaround the disk

Rarefaction, loss of bony trabeculation close to thecartilaginous plate, and an irregular narrowing of the

vertebral disk space

Vertebral body collapse

Rapid bone regeneration may be evident

A paravertebral soft-tissue mass may be present

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DIAGNOSIS MRI of the spine provides information that is not

available with CT scans, paravertebral infection,collections under the posterior longitudinal ligament,and epidural abcesses

Bone scans with technetium Tc 99m are very sensitiveearly indicators of pyogenic vertebral osteomyelitis(become positive long before plain film changes areevident), but is not useful for specificallydifferentiating infection from metastasis orosteoarthritis

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Treatment1. Medical therapy- Antibiotic based on isolated organism- Parenteral antibiotic 6-8 weeks is effective in mostcases

2. Surgical therapy- Indications : Significant ossues involvement Neurological deficits Septic course from an abscess not responding to antibiotics Failure of needle biopsi to obtain necessary cultures Failure of iv antibiotic to eradicate the infection

- Goal : preservation of neural function & achievementof stable fusion without severe kyphosis

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Follow Up Neurologic monitoring

Parenteral antibiotics are given until the infection

resolves Rehabilitation for any residual neurologic deficit

Falling ESR & decrease in serum CRP is consistentwith successful treatment

Serial radiographic studies to detect bony collapseor deformity

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Prognosis Most patients can be cured by a treatment protocol that

includes antibiotics alone or in combination with surgery

Several studies indicate that paresis may improve or resolve

with aggressive antibiotics and surgical therapy

15% patients experience permanent neurological deficits

Recrudescence of infection occurs in 2-8% patients

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Komplikasi Defisit neurologis berkembang pada 13-40% pasien,

terutama mereka dengan diabetes atau penyakitsistemik lainnya.

Terapi antibiotik jangka panjang dapat menyebabkanototoksisitas atau toksisitas ginjal.

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THANK

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Infeksi Vertebra Dept Ilmu Bedah Orthopaedi Dan Traumatologi