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Abstrak :
ABSTRAK
Pendahuluan. Parameter spinopelvik merupakan parameter untuk mengukur keseimbangan poros tulang belakang terhadap ekstrimitas bawah pada penampang sagital. Parameter ini terdiri dari sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateral view dalam keadaan berdiri. Pengukuran parameter ini penting sebagai dasar analisa keseimbangan sagital dalam operasi rekonstruktif tulang belakang, karena dengan tidak adanya keseimbangan pada penampang sagital ini akan berakibat timbulnya adjacent segment degeneration yang akan memengaruhi luaran klinis. Hingga saat ini belum ada studi yang mengevaluasi hubungan antara luaran parameter spinopelvik dengan luaran klinis di indonesia. Metode Penelitian. Penelitian ini adalah penelitian analitik potong lintang dengan subyek 19 pasien dewasa pasca operasi stabilisasi dan fusi tulang belakang torakal dan lumbal di Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta pada tahun 2012-2014. Pasien tersebut dilakukan evaluasi X-ray parameter spinopelvik SVA, PI, PT, dan SS dilakukan penilaian skor Indeks Disabilitas Oswestry (IDO) pada saat 1 tahun pasca operasi. Lalu dilakukan analisis statistik dengan menggunakan uji hipotesis komparatif numerik dengan menggunakan pearson dimana dibandingkan luaran parameter spinopelvik SVA, PI, PT, dan SS dengan luaran fungsional 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). Korelasi antara 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 PI merupakan 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 the sagital 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 lateral view in standing position. Measurement of this parameter is important as basic analysis for achieve sagital balance in reconstructive operation of the vertebrae, because if the sagital balance is interupted will cause the adjacent segment degeneration that will influence the clinical outcomes. Up until now, there is no study that evaluate the spinopelvic parameter with the clinical outcomes in Indonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patient that had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwent x-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluation of Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then the statistical work was done with numeric comparative pearson test analysis to determine whether there is correlation between SVA, PI, PT, and SS with IDO score. 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 between IDO 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 are the important spinopelvic parameter that have influence on clinical outcome in post thoracal and lumbar fusion and stabilization patient. ;Introduction. Spinopelvic parameter is a parameter that used to measure the sagital 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 lateral view in standing position. Measurement of this parameter is important as basic analysis for achieve sagital balance in reconstructive operation of the vertebrae, because if the sagital balance is interupted will cause the adjacent segment degeneration that will influence the clinical outcomes. Up until now, there is no study that evaluate the spinopelvic parameter with the clinical outcomes in Indonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patient that had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwent x-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluation of Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then the statistical work was done with numeric comparative pearson test analysis to determine whether there is correlation between SVA, PI, PT, and SS with IDO score. 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 between IDO 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 are the important spinopelvic parameter that have influence on clinical outcome in post thoracal and lumbar fusion and stabilization patient.

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ABSTRAK
Pendahuluan. Osteoarthritis (OA) adalah sebuah penyakit sendi degeneratif yang menyebabkan disabilitas dengan prevalensi yang terus meningkat. Hormon pertumbuhan memiliki efek regenerasi tulang rawan secara langsung melalui stimulasi sel kondroblas dan proses morphoangiogenesis juga melalui faktor pertumbuhan secara sistemik. Penelitian ini bertujuan untuk mengetahui manfaat suntikan sendi dengan hormon pertumbuhan pada kasus Osteoarthritis. Metode Penelitian. Penelitian dilakukan di Rumah Sakit Hewan Institut Pertanian Bogor pada bulan Mei hingga September 2015. Desain penelitian adalah randomized post test only control group. Sejumlah 21 ekor kelinci Selandia Baru putih, berat 1.9-2.6kg, usia 7-8 bulan. Kelinci dibagi secara acak menjadi kelompok kontrol (NaCl 0.9%), suntikan hormon pertumbuhan (4iu), dan suntikan asam hyaluronat (6mg) . Dengan metode acak tersamar dilakukan suntikan kolagenase tipe II C. Histolyticum pada hari 1 dan ke 4 pada lutut kiri, kemudian tindakan penyuntikan dilakukan sebanyak tiga kali dengan selang waktu 1 minggu. Evaluasi dengan periode kepincangan, skoring makroskopis, histologis dilakukan pada minggu ke-8 pasca penyuntikan pertama. Temuan Penelitian. Berdasarkan hasil penelitian ditemukan periode kepincangan pada grup yang diberikan hormon pertumbuhan lebih singkat, dan bermakna secara statistik dibandingkan dengan grup kontrol (p<0.001), grup asam hyaluronat (p<0.03), dan grup hormon pertumbuhan (p<0.001). Evaluasi skor makroskopik dengan skor yoshimi menunjukan bahwa kelompok hormon pertumbuhan memiliki kerusakan tulang rawan yang lebih ringan jika dibandingkan dengan grup kontrol (p=0.001) dan grup asam hyaluronat (p=0.04). Skoring histopatologis menggunakan skor modifikasi Mankin menunjukan pada kelompok dengan hormon pertumbuhan memiliki angka terendah dibandingkan grup lainnya (p=0.001), grup kontrol (p=0.001), grup asam hyaluronat (p=0.015). Kesimpulan. Suntikan hormon pertumbuhan ke dalam sendi memiliki efektifitas yang lebih baik dibandingkan dengan Asam hyaluronat pada model osteoarthritis. Hormon pertumbuhan memberikan harapan baru sebagai alternatif dalam terapi osteoarthritis.ABSTRACT
Introduction. Osteoarthritis is a degenerative joint disorder that cause disability for patients all over the globe, with an increasing number of patients. Growth hormone (GH) works trough direct and indirect effect on cartilage regeneration by chondroblast stimulation, stimulation of growth factors and morphoangiogenesis process. Further research is needed to know the effects of intra articular joint injection of growth hormone using validated animal model and reliable outcome measurement. Methods. This study was conducted in Animal Hospital of Agricultural Institute Bogor west Java, from May to September 2015. The design of the study was randomized 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 was randomized and divided into three groups. All groups recieved intra articular injection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1 and 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 for consecutive 3 weeks. Evaluation of weight and lameness periode is done periodically, histopathological and macroscopic score were done at 8 weeks since the first injection. Result. The lameness priode for control group is significantly longer than both of the 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 the HA group (P=0.04) and placebo (P=0.01). Histopathological score was also found lowest 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 more effective compared to hyaluronic acid on rabbit osteoarthritis model. This results showed promising result for intra articular injection of GH as an alternative treatment for osteoarthritis.;Introduction. Osteoarthritis is a degenerative joint disorder that cause disability for patients all over the globe, with an increasing number of patients. Growth hormone (GH) works trough direct and indirect effect on cartilage regeneration by chondroblast stimulation, stimulation of growth factors and morphoangiogenesis process. Further research is needed to know the effects of intra articular joint injection of growth hormone using validated animal model and reliable outcome measurement. Methods. This study was conducted in Animal Hospital of Agricultural Institute Bogor west Java, from May to September 2015. The design of the study was randomized 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 was randomized and divided into three groups. All groups recieved intra articular injection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1 and 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 for consecutive 3 weeks. Evaluation of weight and lameness periode is done periodically, histopathological and macroscopic score were done at 8 weeks since the first injection. Result. The lameness priode for control group is significantly longer than both of the 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 the HA group (P=0.04) and placebo (P=0.01). Histopathological score was also found lowest 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 more effective compared to hyaluronic acid on rabbit osteoarthritis model. This results showed promising result for intra articular injection of GH as an alternative treatment for osteoarthritis.;Introduction. Osteoarthritis is a degenerative joint disorder that cause disability for patients all over the globe, with an increasing number of patients. Growth hormone (GH) works trough direct and indirect effect on cartilage regeneration by chondroblast stimulation, stimulation of growth factors and morphoangiogenesis process. Further research is needed to know the effects of intra articular joint injection of growth hormone using validated animal model and reliable outcome measurement. Methods. This study was conducted in Animal Hospital of Agricultural Institute Bogor west Java, from May to September 2015. The design of the study was randomized 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 was randomized and divided into three groups. All groups recieved intra articular injection of type 2 collagenase (Sigma® Missouri) 2mg at the left knee on day 1 and 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 for consecutive 3 weeks. Evaluation of weight and lameness periode is done periodically, histopathological and macroscopic score were done at 8 weeks since the first injection. Result. The lameness priode for control group is significantly longer than both of the 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 the HA group (P=0.04) and placebo (P=0.01). Histopathological score was also found lowest 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 more effective compared to hyaluronic acid on rabbit osteoarthritis model. This results showed promising result for intra articular injection of GH as an alternative treatment for osteoarthritis.

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ABSTRAK
Pendahuluan. 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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ABSTRACT
Introduction 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

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ABSTRAK
Pendahuluan 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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ABSTRACT
Introduction 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.

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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.