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"Pendahuluan: Stenosis kanal lumbal (SKL) adalah gangguan yang disebabkan oleh penyempitan kanal spinal. Derajat penyempitan kanal spinal dapat ditentukan oleh kriteria Herzog yang diukur dengan pemeriksaan MRI. Tujuan penelitian ini adalah untuk mengetahui luaran klinis pasien SKL dengan berbagai derajat stenosis setelah dekompresi dan stabilisasi posterior.Metode: Penelitian ini menggunakan studi kohort retrospektif di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dari bulan Agustus hingga September 2017 dengan teknik total sampling. SKL diklasifikasikan berdasarkan kriteria Herzog. Luaran klinis diukur dengan menghitung skor ODI sebelum operasi dan satu tahun setelah operasi.Hasil: 39 subyek penelitian memiliki rerata usia 58,41±5,86 tahun dan terdiri dari 24 perempuan dan 15 laki-laki. Berdasarkan kriteria Herzog, subyek penelitian yang diklasifikasikan dalam derajat medium 12 (30,8%) dan severe 27 (69,2%). Nilai median skor ODI pada kelompok medium 57 dan severe 60. Setelah operasi, nilai median pada kedua grup turun menjadi 6. Secara statistik, terdapat perbedaan bermakna nilai skor ODI pada kelompok medium (p 0,002) dan kelompok severe (p 0,001), sebelum dan setelah operasi. Sementara itu, tidak ada hubungan bermakna antara skor Herzog dan ODI sebelum operasi (p 0,192) dan setelah operasi (p 0,249).Diskusi: Luaran klinis pasien SKL tergolong baik karena skor ODI mengalami penurunan setelah tindakan dekompresi dan stabilisasi posterior sehingga tindakan tersebut mempengaruhi luaran klinis pasien SKL.

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Background: Lumbar canal stenosis (LCS) is a disorder that caused by the narrowing of the spinal canal. The stage of narrowing is based on Herzog criteria measured from MRI examination. The aim of study was to know clinical outcomes of LCS patients in different stage of stenosis after decompression and posterior stabilization.Methods: This research used retrospective cohort study design and carried out at Cipto Mangunkusumo General Hospital from August to September 2017 with total sampling technique. LCS was classified based on Herzog criteria. Clinical outcome was measured by counting The ODI score before the operative procedure, and one year after the operative procedure.Results: All 39 subjects was 58.41±5.86 years old and consisted of 24 females and 15 males. Based on herzog criteria, the subjects are classified into medium 12 (30,8%) and severe stage 27 (69.2%). The median of ODI score at medium group was 57 and severe group 60. After operative procedure, the median of ODI score at each groups was decreased to 6. Statistically, there was a significant corelation bertween of ODI score in medium (p 0,002) and severe group (p 0,001), to pre and postoperative procedure. No significant correlation between herzog and ODI score preoperative (p 0,192) and postoperative (p 0,249).Discussions: The clinical outcome of LCS patients is good because the ODI score decreases after decompression and posterior stabilization so the procedure affects clinical outcomes of LCS patients."

"Latar Belakang: Stenosis kanal lumbal SKL merupakan suatu kondisi yang potensial menimbulkan disabilitas dan seringkali ditemukan seiring meningkatnya usia populasi. Studi bertujuan menganalisa hubungan antara luaran klinis pasien SKL dan klasifikasi stenosis berdasarkan MRI. Metode: Studi kohort prospektif ini dilakukan di Rumah Sakit Cipto Mangunkusumo RSCM pada januari hingga juli 2016 melalui metode consecutive sampling. Tiga puluh delapan sampel didapat dan kesemuanya dilakukan tatalaksana pembedahan yang sama yaitu dekompresi dan stabilisasi posterior. Subjek dikategorikan ke dalam 4 kategori berdasarakan pemeriksaan MRI menggunakan klasifikasi Schizas. Pemeriksaan pra dan pasca operasi 3 bulan dan 6 bulan dilakukan menggunakan Visual Analogue Scale VAS, Oswestry Disability Index ODI, Japanese Orthopaedic Association Score JOA and Roland Morris Disability Questionnaire RMDQ. Analisis statistic dilakukan dengan menggunakan program SPSS v19. Hasil: Rata ndash; rata usia dari 38 sampel yang didapatkan adalah 58.92 tahun rentang 50-70 tahun. Terdapat 16 orang laki ndash; laki dan 22 orang perempuan. Sebagian besar pasien diklasifikasikan pada grade C berdasarkan klasifikasi Schizas. Perbaikan skor klinis pada subjek laki ndash; laki didapatkan lebih tinggi dibanding perempuan dan hasilnya didapatkan bermakna pada pengukuran VAS pascaoperasi 6 bulan p=0.003 dan JOA pascaoperasi 3 bulan p=0.029. Tidak ditemukan perbedaan bermakna antara derajat klasifikasi berdasarkan MRI dengan skor perbaikan klinis preoperasi, 3 bulan dan 6 bulan pasca operasi menurut VAS p=0.451, p=0.738, p=0.448, ODI p=0.143, p=0.929, p=0.796, JOA p=0.157, p=0.876, p=0.961 dan RMDQ p=0.065, p=0.057, p=0.094. Simpulan: Terdapat perbaikan klinis setelah dilakukan operasi dekompresi dan stabilisai posterior yang ditandai dengan perbaikan skor VAS, ODI, JOA dan RMDQ pasca operasi 3 dan 6 bulan. Tidak terdapat hubungan antara derajat SKL dengan skor VAS, ODI, JOA dan RMDQ.

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Background: Lumbar canal stenosis LCS is a condition which can potentially cause disability and often discovered within the increasing age of population. The aim of this study was to analyze the correlation between clinical outcome of postoperative patients and classifications that are based from MRI assesments.

Method: This prospective cohort study was carried out a Cipto Mangunkusumo General Hospital from January till july 2016 obtained using consecutive sampling. Thirty eight samples were obtained and all of them were managed with same surgical technique that was decompression and posterior stabilization. Patients were categorized in 4 types based on MRI examination using Schizas Classification. Pre and post treatment 3 month and 6 month assessment of the patients was done according to Visual Analogue Scale VAS, Oswestry Disability Index ODI, Japanese Orthopaedic Association Score JOA and Roland Morris Disability Questionnaire RMDQ. Statistical analysis was performed using statitiscal program for social science SPSS v.19.

Result: From 38 samples that were obtained average age was 58.92 years old range 50 70 years old. There were 16 males and 22 females. Most of patients are classified in type C 21 subjects based on MRI examination. The improvement of clinical score in male subjects were better dan female subjects and significantly different in 6 month postoperative VAS p 0.003 and 3 month postoperative JOA score p0.029. In this study was found that generally VAS, ODI, JOA and RMDQ score improved along follow up time. There was no statistical differences between MRI based classification and clinical outcome in preoperative, 3 and 6 month postoperative according to VAS p 0.451, p 0.738, p 0.448, ODI p 0.143, p 0.929, p 0.796, JOA p 0.157, p 0.876, p 0.961 dan RMDQ p 0.065, p 0.057, p 0.094.

Conclusion: There was clinical improvement after decompression and posterior stabilization in lumbar canal stenosis which were manifested in 3 and 6 months post operation of VAS ODI, JOA and RMDQ score. There was no association between degree of LCS and VAS, ODI, JOA and RMDQ score. "

"ABSTRAK Pendahuluan. Parameter spinopelvik merupakan parameter untuk mengukurkeseimbangan poros tulang belakang terhadap ekstrimitas bawah pada penampangsagital. Parameter ini terdiri dari sagittal vertical axis (SVA), pelvic incidence(PI), pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spinelateral view dalam keadaan berdiri. Pengukuran parameter ini penting sebagaidasar analisa keseimbangan sagital dalam operasi rekonstruktif tulang belakang,karena dengan tidak adanya keseimbangan pada penampang sagital ini akanberakibat timbulnya adjacent segment degeneration yang akan memengaruhiluaran klinis. Hingga saat ini belum ada studi yang mengevaluasi hubungan antaraluaran parameter spinopelvik dengan luaran klinis di indonesia.Metode Penelitian. Penelitian ini adalah penelitian analitik potong lintang dengansubyek 19 pasien dewasa pasca operasi stabilisasi dan fusi tulang belakang torakaldan lumbal di Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta pada tahun2012-2014. Pasien tersebut dilakukan evaluasi X-ray parameter spinopelvik SVA,PI, PT, dan SS dilakukan penilaian skor Indeks Disabilitas Oswestry (IDO) padasaat 1 tahun pasca operasi. Lalu dilakukan analisis statistik dengan menggunakanuji hipotesis komparatif numerik dengan menggunakan pearson dimanadibandingkan luaran parameter spinopelvik SVA, PI, PT, dan SS dengan luaranfungsional skor IDO.Temuan dan Diskusi Penelitian. Didapatkan hasil korelasi antara IDO dan SVA (p<0,001) (r=0,866). Korelasi antara IDO dan PI (p=0,006) (r=0,603). Korelasiantara IDO dan PT (p=0,107) (r=0,382). Korelasi IDO dan SS (p=0,051)(r=0,454).Simpulan. Didapatkan korelasi kuat antara IDO dan SVA serta IDO dan PI.Tidak didapatkan korelasi antara IDO dan PT serta IDO dan SS. SVA dan PImerupakan parameter spinopelvik yang berpengaruh pada luaran pasca operasi fusi tulang belakang torakal dan lumbal. ABSTRACT Introduction. Spinopelvic parameter is a parameter that used to measure thesagital balance of vertebrae in congruency with lower extrimity in sagital plane.This parametr is consist of sagittal vertical axis (SVA), pelvic incidence (PI),pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateralview in standing position. Measurement of this parameter is important as basicanalysis for achieve sagital balance in reconstructive operation of the vertebrae,because if the sagital balance is interupted will cause the adjacent segmentdegeneration that will influence the clinical outcomes. Up until now, there is nostudy that evaluate the spinopelvic parameter with the clinical outcomes inIndonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patientthat had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr.Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwentx-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluationof Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then thestatistical work was done with numeric comparative pearson test analysis todetermine whether there is correlation between SVA, PI, PT, and SS with IDOscore.Result and Discussion. There is strong correlation between IDO and SVA(p<0,001) (r=0,866). Strong correlation between IDO and PI (p=0,006) (r=0,603).No correlation between IDO and PT (p=0,107) (r=0,382). No correlation betweenIDO and SS (p=0,051) (r=0,454).Conclusion. Strong correlation is indicated in IDO and SVA, also in IDO and PI.There is no correlation between IDO and PT, also in IDO and SS. SVA and PI arethe important spinopelvic parameter that have influence on clinical outcome inpost thoracal and lumbar fusion and stabilization patient. ;Introduction. Spinopelvic parameter is a parameter that used to measure thesagital balance of vertebrae in congruency with lower extrimity in sagital plane.This parametr is consist of sagittal vertical axis (SVA), pelvic incidence (PI),pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateralview in standing position. Measurement of this parameter is important as basicanalysis for achieve sagital balance in reconstructive operation of the vertebrae,because if the sagital balance is interupted will cause the adjacent segmentdegeneration that will influence the clinical outcomes. Up until now, there is nostudy that evaluate the spinopelvic parameter with the clinical outcomes inIndonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patientthat had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr.Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwentx-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluationof Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then thestatistical work was done with numeric comparative pearson test analysis todetermine whether there is correlation between SVA, PI, PT, and SS with IDOscore.Result and Discussion. There is strong correlation between IDO and SVA(p<0,001) (r=0,866). Strong correlation between IDO and PI (p=0,006) (r=0,603).No correlation between IDO and PT (p=0,107) (r=0,382). No correlation betweenIDO and SS (p=0,051) (r=0,454).Conclusion. Strong correlation is indicated in IDO and SVA, also in IDO and PI.There is no correlation between IDO and PT, also in IDO and SS. SVA and PI arethe important spinopelvic parameter that have influence on clinical outcome inpost thoracal and lumbar fusion and stabilization patient. "

"ABSTRAKPendahuluan. Penggunaan autograft dalam fusi interkorpus tulang belakang masih menjadi pilihan utama, tetapi jumlah yang terbatas dan morbiditas pada tempat donor mendorong penggunaan substitusi tulang. Kombinasi HA dan DBM menjadi pilihan utama selain autograft dalam fusi interkorpus, namun hasil yang ada menunjukan variasi diantara jenis DBM. Tujuan penelitian ini untuk mengevaluasi luaran klinis dan radiologis fusi interkorpus lumbal menggunakan kombinasi DBM dan HA.Metode Penelitian. Penelitian ini merupakan prospektif cohort pada 35 pasien yang terbagi atas 18 pasien kelompok autograft dan 17 pasien kelompok kombinasi HA dan DBM. Pasien merupakan pasien spondilosis lumbal yang diindikasikan untuk tindakan operatif. Evaluasi klinis pada masing-masing kelompok pasca operasi menggunakan VAS, JOA dan ODI yang dinilai pada bulan ke-3, 6 dan 12. Evaluasi radiologis pada masing-masing berupa fusi di evaluasi dengan ct scan pada bulan ke-12. Karakteristik pasien seperti jenis kelamin, usia, riwayat merokok, level operasi, dan BMI juga dievaluasi.Temuan Penelitian. Dua orang ahli bedah orthopaedi tulang belakang melakukan operasi stabilisasi posterior dan TLIF. Terdapat 55 pasien (27 kelompok autograft, 28 kelompok kombinasi HA dan DBM) yang masuk ke dalam kriteria, 9 pasien dari masing-masing kelompok di eksklusi karena tidak dapat di follow up sampai 12 bulan. Perbandinagn skor VAS, JOA dan ODI diantara kedua kelompok tidak menunjukan perbedaan yang bermakna dengan nilai p masing-masing 0,599, 0,543 dan 0,780. Perbandingan fusi antara kelompok autograft dan kombinasi HA dan DBM menunjukan nilai p 1,000, sehingga tidak bermakna secara statistik.Simpulan Hasil luaran klinis dan radiologis pada penggunaan kombinasi HA dan DBM dalam fusi interkorpus tidak menunjukan inferioritas bila dibandingkan dengan autograft. Kombinasi HA dan DBM dapat dipertimbangkan sebagai alternatif bagi pasien spondilosis lumbal yang diindikasikan untuk tindakan operatif.

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ABSTRACTIntroduction The use of autograft still remains a gold standard in lumbar interbody fusion surgery, but the limited amount and donor site morbidity encourages the use of bone substitute. Combination of HA and DBM become a main choice other than autograft in lumbar interbody fusion, however there were variable result between DBM product. These research was aimed to evaluate the clinical and radiological outcome of interbody fusion using combination of DBM and HA.Methods A cohort prospective research was conducted in 35 patients that were divided into 18 autograft group patients and 17 combination of HA and DBM group patient. All the patients were diagnosed with lumbar spondylosis and indicated for surgery. Clinical evaluation on each group was evaluated using VAS, JOA and ODI on the 3rd, 6th and 12th month post operatively. Radiologic outcome of fusion was evaluated using ct scan on the 12th month. Other patient characteristic such as sex, age, smoking history, level operation dan BMI were also evaluated in this research.Results Two orthopaedic spine surgeon conducted the posterior stabilization and TLIF procedure. There were 55 patients (27 autograft group patients, 28 combination of HA and DBM group patients) that was included according to the criteria, 9 patients on each group were excluded due to loss of follow up below 12 months. Comparison of VAS, JOA and ODI score between the two group did not show any difference that significant statiscally with the p value was 0.599, 0.543, and 0.780 each. Comparison of fusion rate between the two groups showed p value of 1.000 which was not significant statiscally.Conclusions Clinical and radiological outcome of combination of HA and DBM in lumbar interbody fusion did not show inferiority compared with autograft. Combination of HA and DBM can be considered as an alternative in lumbar spondylosis patient that need operative procedure"

"ABSTRAKPendahuluan Penggunaan tandur tulang lokal saat ini masih menjadi pilihan utama dalam tatalaksana fusi posterolateral pada kasus spondilosis lumbal di negara berkembang. Rendahnya tingkat fusi yang dihasilkan oleh tindakan ini mendorong penggunaan alternatif material lain. Penambahan aspirat sumsum tulang pada tandur tulang lokal dapat menjadi pilihan yang efektif dalam tatalaksana fusi posterolateral pada pasien spondilosis lumbal, namun saat ini belum ada data mengenai luaran klinis dari tatalaksana jenis ini di Indonesia. Metode Penelitian ini merupakan metode Kohort Retrospektif pada 38 pasien dengan tatalaksana fusi posterolateral dengan menggunakan tandur tulang lokal yang terbagi atas 19 pasien kelompok dengan penambahan aspirat sumsum tulang dan 19 pasien kelompok tanpa penambahan aspirat sumsum tulang. Seluruh pasien mendapatkan tindakan operasi setelah tindakan konservatif gagal dalam mengatasi keluhan nyeri. Evaluasi klinis pada masing-masing kelompok menggunakan skor IDO dinilai sebelum operasi, bulan ke-3 dan ke-6 setelah operasi. Hasil Tiga orang Ahli Orthopaedi Divisi Tulang Belakang melakukan operasi fusi posterolateral dan stabilisasi posterior. Perbandingan skor IDO sebelum operasi di antara kedua kelompok tidak menunjukan perbedaan yang bermakna. Tidak terdapat perbedaan bermakna rerata skor IDO pada kedua kelompok hingga bulan ketiga. Namun, perbandingan skor IDO pre operasi dan 6 bulan paska operasi menunjukkan kelompok dengan penambahan aspirat sumsum tulang akan menghasilkan rerata skor IDO lebih baik. Kesimpulan Luaran klinis pasien spondilosis lumbal yang menjalani fusi posteralateral menggunakan tandur tulang lokal dengan penambahan aspirat sumsum tulang menunjukkan hasil yang baik. Penambahan aspirat sumsum tulang pada fusi posterolateral menggunakan tandur tulang lokal dapat dipertimbangkan sebagai alternatif bagi pasien spondilosis lumbal yang diindikasikan untuk tindakan operatif.

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ABSTRACTIntroduction The use of local bone graft still a mainstay in posterolateral fusion surgery for lumbar spondylosis cases in developing countries. Low rates of fusion encourage the alternative use of other materials. The addition of bone marrow aspirates in the local bone graft may be an option in the treatment of posterolateral fusion in the lumbar spondylosis patients, however there is no data on the clinical outcomes of treatment of this procedure in indonesia. Methods A retrospective cohort study was conducted in 38 patients treated by posterolateral fusion using local autograft that were divided into 19 patients with addition of bone marrow aspirates and 19 patients without addition of bone marrow aspirates. All patients received surgery after conservative treatments failed to address the complaint of pain. Clinical evaluation in each group using ODI score assessed preoperatively, 3rd, and 6th month postoperatively. Results Three Orthopedic Spine Surgeon performed posterolateral fusion and posterior stabilization. Comparison of preoperative ODI score between the two groups showed no significant difference. There were no significant differences in ODI score mean in both groups in 3 months after surgery. However, the bone marrow aspirate group produced a better mean difference of ODI score after 6 months. Conclusions The clinical outcomes of lumbal spondylosis patients undergoing posteralateral fusion using local autograft with addition of bone marrow aspirate showed good results. The addition of bone marrow aspirates in posterolateral fusion using local bone graft can be considered as an alternative for lumbar spondylosis patients who are indicated for surgery. "

"ABSTRAK Pendahuluan. Osteoarthritis (OA) adalah sebuah penyakit sendi degeneratif yangmenyebabkan disabilitas dengan prevalensi yang terus meningkat. Hormonpertumbuhan memiliki efek regenerasi tulang rawan secara langsung melaluistimulasi sel kondroblas dan proses morphoangiogenesis juga melalui faktorpertumbuhan secara sistemik. Penelitian ini bertujuan untuk mengetahui manfaatsuntikan sendi dengan hormon pertumbuhan pada kasus Osteoarthritis. Metode Penelitian. Penelitian dilakukan di Rumah Sakit Hewan InstitutPertanian Bogor pada bulan Mei hingga September 2015. Desain penelitian adalahrandomized post test only control group. Sejumlah 21 ekor kelinci Selandia Baruputih, berat 1.9-2.6kg, usia 7-8 bulan. Kelinci dibagi secara acak menjadikelompok kontrol (NaCl 0.9%), suntikan hormon pertumbuhan (4iu), dan suntikanasam hyaluronat (6mg) . Dengan metode acak tersamar dilakukan suntikankolagenase tipe II C. Histolyticum pada hari 1 dan ke 4 pada lutut kiri, kemudiantindakan penyuntikan dilakukan sebanyak tiga kali dengan selang waktu 1minggu. Evaluasi dengan periode kepincangan, skoring makroskopis, histologisdilakukan pada minggu ke-8 pasca penyuntikan pertama. Temuan Penelitian. Berdasarkan hasil penelitian ditemukan periode kepincanganpada grup yang diberikan hormon pertumbuhan lebih singkat, dan bermaknasecara statistik dibandingkan dengan grup kontrol (p<0.001), grup asamhyaluronat (p<0.03), dan grup hormon pertumbuhan (p<0.001). Evaluasi skormakroskopik dengan skor yoshimi menunjukan bahwa kelompok hormonpertumbuhan memiliki kerusakan tulang rawan yang lebih ringan jikadibandingkan dengan grup kontrol (p=0.001) dan grup asam hyaluronat (p=0.04).Skoring histopatologis menggunakan skor modifikasi Mankin menunjukan padakelompok dengan hormon pertumbuhan memiliki angka terendah dibandingkangrup lainnya (p=0.001), grup kontrol (p=0.001), grup asam hyaluronat (p=0.015). Kesimpulan. Suntikan hormon pertumbuhan ke dalam sendi memiliki efektifitasyang lebih baik dibandingkan dengan Asam hyaluronat pada model osteoarthritis.Hormon pertumbuhan memberikan harapan baru sebagai alternatif dalam terapiosteoarthritis.ABSTRACT Introduction. Osteoarthritis is a degenerative joint disorder that cause disabilityfor patients all over the globe, with an increasing number of patients. Growthhormone (GH) works trough direct and indirect effect on cartilage regeneration bychondroblast stimulation, stimulation of growth factors and morphoangiogenesisprocess. Further research is needed to know the effects of intra articular jointinjection of growth hormone using validated animal model and reliable outcomemeasurement. Methods. This study was conducted in Animal Hospital of Agricultural InstituteBogor west Java, from May to September 2015. The design of the study wasrandomized posttest only control group. Male white New Zealand rabbit (n=21)weighted 1.9-2.6kg, age 6-7months were used in this study. The sample wasrandomized and divided into three groups. All groups recieved intra articularinjection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1and 4. Injections of growth hormone (4iu), hyaluronic acid (HA) (6mg) and saline(0.6ml) were done at 2 weeks after collagenase injection once a week forconsecutive 3 weeks. Evaluation of weight and lameness periode is doneperiodically, histopathological and macroscopic score were done at 8 weeks sincethe first injection. Result. The lameness priode for control group is significantly longer than both ofthe experimental groups (p<0.001), HA (p<0.03), and GH (p<0.001).Macroscopic score evaluation taken from the lateral condyle of the left femur showed that the GH group received significantly less cartilage damage than theHA group (P=0.04) and placebo (P=0.01). Histopathological score was also foundlowest at the GH group (p=0.001), with significant difference in control(p=0.001), and HA group (p=0.015).).Conclusion. Intraarticular injection of growth hormone is found to be moreeffective compared to hyaluronic acid on rabbit osteoarthritis model. This resultsshowed promising result for intra articular injection of GH as an alternativetreatment for osteoarthritis.;Introduction. Osteoarthritis is a degenerative joint disorder that cause disabilityfor patients all over the globe, with an increasing number of patients. Growthhormone (GH) works trough direct and indirect effect on cartilage regeneration bychondroblast stimulation, stimulation of growth factors and morphoangiogenesisprocess. Further research is needed to know the effects of intra articular jointinjection of growth hormone using validated animal model and reliable outcomemeasurement. Methods. This study was conducted in Animal Hospital of Agricultural InstituteBogor west Java, from May to September 2015. The design of the study wasrandomized posttest only control group. Male white New Zealand rabbit (n=21)weighted 1.9-2.6kg, age 6-7months were used in this study. The sample wasrandomized and divided into three groups. All groups recieved intra articularinjection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1and 4. Injections of growth hormone (4iu), hyaluronic acid (HA) (6mg) and saline(0.6ml) were done at 2 weeks after collagenase injection once a week forconsecutive 3 weeks. Evaluation of weight and lameness periode is doneperiodically, histopathological and macroscopic score were done at 8 weeks sincethe first injection. Result. The lameness priode for control group is significantly longer than both ofthe experimental groups (p<0.001), HA (p<0.03), and GH (p<0.001).Macroscopic score evaluation taken from the lateral condyle of the left femur showed that the GH group received significantly less cartilage damage than theHA group (P=0.04) and placebo (P=0.01). Histopathological score was also foundlowest at the GH group (p=0.001), with significant difference in control(p=0.001), and HA group (p=0.015).).Conclusion. Intraarticular injection of growth hormone is found to be moreeffective compared to hyaluronic acid on rabbit osteoarthritis model. This resultsshowed promising result for intra articular injection of GH as an alternativetreatment for osteoarthritis.;Introduction. Osteoarthritis is a degenerative joint disorder that cause disabilityfor patients all over the globe, with an increasing number of patients. Growthhormone (GH) works trough direct and indirect effect on cartilage regeneration bychondroblast stimulation, stimulation of growth factors and morphoangiogenesisprocess. Further research is needed to know the effects of intra articular jointinjection of growth hormone using validated animal model and reliable outcomemeasurement. Methods. This study was conducted in Animal Hospital of Agricultural InstituteBogor west Java, from May to September 2015. The design of the study wasrandomized posttest only control group. Male white New Zealand rabbit (n=21)weighted 1.9-2.6kg, age 6-7months were used in this study. The sample wasrandomized and divided into three groups. All groups recieved intra articularinjection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1and 4. Injections of growth hormone (4iu), hyaluronic acid (HA) (6mg) and saline(0.6ml) were done at 2 weeks after collagenase injection once a week forconsecutive 3 weeks. Evaluation of weight and lameness periode is doneperiodically, histopathological and macroscopic score were done at 8 weeks sincethe first injection. Result. The lameness priode for control group is significantly longer than both ofthe experimental groups (p<0.001), HA (p<0.03), and GH (p<0.001).Macroscopic score evaluation taken from the lateral condyle of the left femur showed that the GH group received significantly less cartilage damage than theHA group (P=0.04) and placebo (P=0.01). Histopathological score was also foundlowest at the GH group (p=0.001), with significant difference in control(p=0.001), and HA group (p=0.015).).Conclusion. Intraarticular injection of growth hormone is found to be moreeffective compared to hyaluronic acid on rabbit osteoarthritis model. This resultsshowed promising result for intra articular injection of GH as an alternativetreatment for osteoarthritis."

"Herniasi Nukleus Pulposus (HNP) lumbal adalah kondisi yang disebabkan proses degenerasi dari diskus intervertebralis (DIV) yang sering terjadi pada area lumbal. Kondisi ini dapat berkaitan dengan keluhan nyeri punggung bawah yang mengakibatkan kesakitan dan penurunan dari kualitas hidup pasien. Tindakan Percutaneous Laser Disc Reconstruction (PLDR) adalah tindakan yang diaplikasikan ke jaringan DIV untuk menginduksi proses regenerasi, perbaikan pada diskus yang mengalami kerusakan, dan mengurangi nyeri pada pasien. Studi prospektif cohort ini dilakukan di RSUPN Dr. Cipto Mangunkusumo dan RSUD Dr. Moewardi Surakarta, yang melibatkan 21 pasien dengan HNP lumbal. Pemilihan sampel berdasarkan kriteria inklusi dan eksklusi tertentu menggunakan sampel purposif. Variabel yang dianalisis meliputi Visual Analoque Scale (VAS), Oswestry Disability Index (ODI), PROMIS (Patient-Reported Outcomes Measurement Information System) Global 10, dan Pfirrmann Grading berdaraskan MRI. Studi ini memperoleh persetujuan etik dari Komite Etik RSUPN Dr. Cipto Mangunkusumo dan RSUD Dr. Moewardi Surakarta. Analisis statistik yang digunakan untuk menguji luaran klinis tindakan PLDR pada pasien HNP Lumbal adalah Uji Mann Whitney (p<0.05) dan Wilcoxon rank test. Evaluasi setelah 3 bulan pasca tindakan PLDR yang diberikan kepada pasien dengan HNP lumbal memberikan perbaikan rasa nyeri berdasarkan skor VAS sebesar 51,3% (rata-rata 7.25±0.68 menjadi 3.67±0.48). Tindakan PLDR juga memberikan perbaikan pada kualitas hidup pasien di mana terdapat perbaikan skor ODI sebesar 58,8% (rata-rata 38.57±7.19 menjadi 15.90±4.84) dan terdapat perbaikan skor SF-36 sampai sebesar 65,1% (rata-rata 46,43±9,64 menjadi 76,67±3,65) pada komponen health change. Evaluasi MRI berdasarkan Pfirrmann Grading menunjukkan adanya penurunan yang signifikan (p<0,05) pasca tindakan PLDR. Evaluasi skor PROMIS didapatkan skor Pain Interference 43.33±5.80 dan Physical function 50.76±2.43 yang menunjukkan skor PROMIS post tindakan PLDR masih belum mencapai nilai maksimal.

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Lumbar Nucleus Pulposus Herniation is a common condition caused by the degeneration process of the intervertebral disc in the lumbar area. This condition can be associated with complaints of lower back pain which results in disability and a decrease in the patient's quality of life. Percutaneous Laser Disc Reconstruction (PLDR) is a procedure applied to disc tissue, to induce the regeneration process, repair damaged discs, and reduce pain in patients. This prospective cohort study was conducted at Dr. Cipto Mangunkusumo Hospital and Dr. Moewardi Hospital Surakarta, involving 21 patients with lumbar HNP. Sample selection is based on certain inclusion and exclusion criteria using purposive sampling. Variables analyzed included the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), PROMIS (Patient-Reported Outcomes Measurement Information System) Global 10, and Pfirrmann Grading.Evaluation after 3 months post PLDR given to patients with lumbar HNP provided an improvement in pain based on the VAS score of 51.3% (average 7.25±0.68 to 3.67±0.48). The PLDR procedure also provided an improvement in the patient's quality of life where there was an improvement in the ODI score of 58.8% (average 38.57±7.19 to 15.90±4.84) ​​and there was an improvement in the SF-36 score of up to 65.1% (average 46.43±9.64 to 76.67±3.65) in the health change component. MRI evaluation based on Pfirrmann Grading showed a significant decrease (p<0.05) after PLDR. PROMIS score evaluation obtained Pain Interference score of 43.33±5.80 and Physical function score of 50.76±2.43, showed that PROMIS score after PLDR had not yet reached the maximum value."

"Lumbar canal stenosis merupakan penyebab utama disabilitas pasien. Selective Nerve Root Block (SNRB) pada area lumbar adalah salah satu metode terapi untuk mengatasi nyeri akibat radikulopati lumbar yang bertujuan mengurangi kebutuhan operasi. Ultrasonografi (USG) muncul sebagai alternatif dengan kelebihan seperti tanpa radiasi, mobilitas tinggi, kemampuan pencitraan jaringan lunak, dan penetrasi jarum real-time jika dibandinagkan menggunakan Floroskopi. Penelitian ini merupakan studi uji klinis acak non-inferiority tersamar tunggal yang dilakukan di 2 Rumah Sakit. 52 subjek penelitian yang terdiri dari 26 subjek yang dilakukan tindakan SNRB dengan panduan fluoroskopi dan 26 subjek yang dilakukan tindakan SNRB dengan panduan USG. Tidak ada perbedaan karakteristik dasar antara kedua kelompok berdasarkan usia, jenis kelamin, IMT, durasi gejala. level lumbar VAS, maupun ODI pre operasi (p > 0,05). Penelitian ini menunjukkan penurunan signifikan pada nilai VAS di kelompok floroskopi dan USG pada 30 menit, 2 minggu, dan 12 minggu setelah tindakan dibandingkan dengan baseline (p < 0,01). Kendati demikian, tidak ada perbedaan VAS dan ODI yang signifikan antara kedua metode panduan pada setiap titik waktu (p > 0,05). Tidak terdapat perbedaan dalam pengurangan nyeri radikular lumbal, skor ODI, dan kejadian komplikasi antara tindakan SNRB dengan panduan fluoroskopi maupun USG. Penggunaan panduan USG pada SNRB terbukti lebih efisien dengan durasi yang lebih singkat dan sama efektifnya dengan fluoroskopi.

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Lumbar canal stenosis is a leading cause of patient disability. Selective Nerve Root Block (SNRB) in the lumbar area is a therapeutic method aimed at alleviating pain from lumbar radiculopathy to reduce disability and surgical needs. SNRB typically employs fluoroscopy but has drawbacks such as radiation exposure. Ultrasonography (USG) has emerged as an alternative offering benefits. This was a randomized single-blind non-inferiority clinical trial conducted at 2 Hospitals. There were 52 subjects, with 26 undergoing SNRB with fluoroscopy guidance and 26 with USG guidance. No baseline characteristic differences were found between the groups in terms of age, gender, BMI, symptom duration, preoperative lumbar level VAS, or ODI (p > 0.05). The study demonstrated significant reductions in VAS scores in both fluoroscopy and USG groups at 30 minutes, 2 weeks, and 12 weeks post-procedure compared to baseline (p < 0.01). However, no significant differences in VAS and ODI were observed between the two guidance methods at any time point (p > 0.05). There was no difference in the reduction of lumbar radicular pain, ODI scores, and complication rates between SNRB procedures guided by fluoroscopy and USG. USG guidance in SNRB proves to be more efficient with shorter duration and equally effective as fluoroscopy."

"Mobilisasi dini pasca operasi merupakan salah satu intervensi yang penting pada periode pasca operasi yang dapat mempersingkat hari rawat LOS dan mencegah komplikasi post operasi. Namun demikian, mobilisasi pasca operassi merupakan elemen asuhan keperawatan yang kadang terlupakan. Tujuan penulisan adalah untuk menganalisis intervensi program mobilisasi dini pada klien Ny.S 60 tahun dengan lumbal spinal stenosis L4-L5 pasca operasi dekompresi dan pemasangan TLIF Transforaminal Lumbar Interbody Fusion dengan riwayat hipertensi, obesitas dan foot drop dextra. Intervensi dilakukan selama lima hari perawatan yang meliputi edukasi kesehatan, latihan kekuatan otot, mobilisasi di tempat tidur, hingga mobilisasi jalan dengan menggunakan walker. Hasil pelaksanaan intervensi adalah kemampuan klien dalam mobilisasi meningkat yang ditunjukan dengan pencapaian 6 dari 8 skor JH-HLM John Hopkins Highest Level of Mobilty yaitu klien mampu berjalan lebih dari 10 langkah dalam 5 hari perawatan. Selain itu, kondisi umum klien meningkat yaitu secara fisik meliputi: klien lebih aktif untuk merubah posisi dan bergerak, keluhan nyeri dan kelelahan jarang, mengatakan lebih nyaman dan tubuhnya tidak kaku ; emosional meliputi: mood tampak baik, kecemasan untuk mobilisasi minimal, kooperatif dalam program mobilisasi , dan sosial meliputi: peningkatan tingkat kemandirian klien untuk mobilisasi, keluarga berpartisipasi aktif dalam mendukung dan mendampingi klien dalam program mobilisasi. Hasil analisis menunjukan bahwa intervensi program mobilisasi dini pasca operasi berdampak positif terhadap hasil perawatan pasca operasi klien sehingga perlu menjadi prioritas dalam asuhan keperawatan pasca operasi.

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Early postoperative mobilization is one of the most important interventions in the postoperative period that can shorten length of stay LOS and prevent postoperative complications. However, postoperative mobilization is the most frequently overlooked element of nursing care. The purpose of the writing was to analyze the early mobilization program on the Ny.S 60 years old client with Lumbar L4 L5 spinal stenosis post decompression and TLIF Transforaminal Lumbar Interbody Fusion installation with history of hypertension, obesity, and foot drop dextra. Interventions were performed for five days of care that included health education, muscle strength training, bed mobilization, to out of bed mobilization using walkers.

The result of the intervention was client's ability to mobilize has increased which has been shown in the achievement of 6 of 8 JH HLM score John Hopkins Highest Level of Mobilty which client can walked more than 10 steps within 5 days of treatment. Client's general condition also improved which physical aspect including the client were more active to change position and moved, rare to complaint pain and tiredness, said more comfortable and her body more relaxed emotional aspect including good mood, minimal anxiety during mobilization, cooperative in mobilization program , social aspect including the level of client independence for mobilization increased, the family actively participated in supporting and assisting clients in the mobilization program. The results of the analysis showed that the intervention of early postoperative mobilization program had a positive impact on client's postoperative outcomes, therefore it needs to be a priority interventions in postoperative nursing care. "