Tesis

Analisis Luaran Klinis Dan Radiologis Pasca Koreksi Operatif Pada Pasien Spondilitis Tuberkulosis Dengan Deformitas Kifosis Di Rsupn Cipto Mangunkusumo Jakarta = Analysis of Clinical and Radiological Outcome Post- Surgery Correction in Spondylitis Tuberculosis Patients with Kyphotic Deformity at Rsupn Ciptomangunkusumo Jakarta.

Introduksi Spondilitis tuberculosis (TB) merupakan kasus infeksi tulang belakang tersering terutama di negara berkembang. Tiga hingga 5% kasus Spondilitis TB berkembang menjadi deformitas kifosis >60 derajat. Deformitas kifosis dapat mengakibatkan paraplegia dan gangguan fungsi lainnya, sehingga harus ditatalaksana dan dicegah dengan koreksi operatif. Studi ini bertujuan untuk mengetahui luaran klinis dan radiologis pada deformitas kifosis pasca koreksi operatif dan hubungannya dengan faktor-faktor yang memengaruhi deformitas kifosis. Metode Penelitian ini menggunakan desain potong lintang terhadap pasien Spondilitis TB dengan deformitas kifosis yang dilakukan tindakan koreksi operatif selama tahun 2014-2018 di RSUPN Cipto Mangunkusumo. Dilakukan penilaian luaran klinis ODI (Oswestry Disability Index) dan ASIA Impairment Scale, serta penilaian radiologis berupa persentase derajat koreksi dan loss of correction. Penilaian tersebut dilakukan pada saat pra-operasi, pasca-operasi, 6 dan 12 bulan pasca operasi, serta saat kontrol terakhir. Hasil Dari 78 pasien yang diikut sertakan dalam penelitian ini, rata-rata berusia 31,4 tahun dan mayoritas perempuan. Gejala awal tersering adalah backpain. Median jumlah keterlibatan vertebra adalah 2 dengan lokasi tersering pada level torakal. Durasi kontrol adalah 6 hingga 54 bulan. Pemilihan teknik operasi posterior lebih sering digunakan dibanding kombinasi dan tidak terdapat perbedaan yang bermakna pada pemilihan teknik operasi dengan luaran klinis maupun radiologis (p > 0,05). Terdapat perbedaan yang bermakna secara statistik pada perbandingan nilai klinis, dan radiologis pre dengan pasca operasi (p < 0,001). Perbaikan neurologis ASIA scale tampak mulai signifikan sejak 6 bulan pasca operasi (p < 0,001). Sudut kifosis awal memberikan pengaruh yang signifikan terhadap semua kategori luaran (p < 0,001). Terdapat komplikasi berupa pseudoarthrosis pada 2 pasien dan defisit neurologis yang menetap pada 1 pasien. Kesimpulan Tatalaksana operasi korektif pada pasien spondilitis TB dengan deformitas kifosis menunjukkan perbaikan luaran klinis, laboratorium dan radiologis. Sudut awal kifosis mempengaruhi luaran klinis dan radiologis.
Kata kunci: Spondilitis TB, deformitas kifosis, luaran, sudut kifosis, index disabilitas oswestry, ASIA impairment scale, loss of correction


Introduction Spondylitis tuberculosis (TB) is the most common case of spinal infection, especially in developing countries. Three to 5 % of Spondylitis TB cases will develop into more than 60 o of kyphotic deformity. Kyphotic deformity can cause late paraplegia and other functional disturbances, therefore a kyphotic correction should be performed to prevent and treat the complications. The purpose of the study is to analyze the clinical and radiological outcome of kyphotic deformity in Spondylitis TB patients post kyphotic correction and to analyze the factors influencing the kyphotic deformity Method This study used cross-sectional design on Spondylitis TB patients who underwent corrective surgery as one of the treatment during 2014-2018 at Cipto Mangunkusumo Hospital. Evaluation of delta ODI (Oswestry Disability Index) and ASIA impairment scale were used to assess the clinical outcome. For radiological outcome, we assessed the percentage of correction and loss of correction. The data was collected from the medical record and also the patient; pre-surgery, postsurgery, 6 and 12 months post-surgery, also the current condition Result Out of the 78 patients included in this study, the average age was 31.4 years and for the majority of women. The majority of initial symptoms was complaint of backpain. The median number of vertebral involvement was 2, the majority of the location of the vertebrae involved were at the thoracic level. The choice of posterior surgery techniques is more often used than combination (posterior-anterior), however no significant differences was found when we compared the technique used with the clinical and radiological outcome (p > 0,005) There were significant differences between pre and post-operative clinical and radiological value (p < 0,001). Neurological improvement (ASIA scale) appears to be significant since 6 months postoperatively (p < 0.001). Pre-operative kyphotic angle was found to be an influential factor in all outcome categories (p < 0,001). There was pseudoarthrosis in 2 patients and refracter neurological deficit in 1 patient. Conclusion Surgical correction Spondylitis TB patients with kyphotic deformity shows improvement seen from clinical, laboratory and radiological outcomes. Preoperative kyphotic angle affects the clinical and radiological outcome.
Keywords: Spondylitis Tuberculosis, kyphotic deformity, outcome, kyphotic angle, oswestry disability index, ASIA impairment scale, loss of correction