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"Pendahuluan Biportal Endoscopic Spine Surgery (BESS) merupakan salah satu metode minimal invasif untuk melakukan dekompresi struktur saraf pada Degeneratif Lumbal Canal Stenosis (DLCS). Teknik ini memiliki keunggulan dibandingkan teknik lainnya dalam preservasi jaringan lunak dan struktur posterior tulang belakang. Penambahan prosedur discectomy pada pembedahan terbuka diketahui akan menyebabkan penurunan tinggi diskus secara signifikan, mempercepat proses degenerasi pada diskus itu sendiri sehingga akan merubah biomekanika segmen vertebra dan menimbulkan nyeri bahkan instabilitas di kemudian hari. Untuk itu, dilakukan penelitian dengan membandingkan hasil luaran klinis dan radiologis pada DLCS yang dilakukan BESS dengan penambahan discectomy dan tanpa discectomyMetodologi Penelitian ini mengambil data dari 48 subjek DLCS yang memenuhi kriteria inklusi yang telah menjalani prosedur BESS. Kemudian dibagi menjadi kelompok BESS discectomy sebanyak 24 subjek dan BESS tanpa discectomy sebanyak 24 subjek secara consecutive sampling. Pada masing-masing kelompok dinilai luaran klinis berupa skala nyeri Numerical Rating Scale (NRS) dan skor Oswestry Disability Index (ODI) pre dan 1 tahun pasca operasi. Luaran radiologis dinilai berupa tinggi diskus pada x ray lumbal lateral berdiri pre dan pasca 1 tahun operasi dan adanya instabilitas dinilai dari translasi sagittal dinamik, angulasi sagittal dinamik pada x ray lumbal dinamik berdiri 1 tahun pasca operasiHasil Dari 48 orang subjek pada penelitian ini, rerata usia sebesar 57.56+8.37, sebagian besar berjenis kelamin perempuan 31 (64.6%), dengan level stenosis terbanyak pada L4-5 yaitu sebesar 64.6%, diikuti L5-S1 sebesar 25% dan L3-4 10.4%. Pada kelompok BESS discectomy didapatkan perbedaan yang bermakna terhadap skala nyeri NRS back dan leg pain, skor ODI, serta penurunan tinggi diskus pre dan pasca operasi 1 tahun (p<0,001), begitu juga dengan kelompok BESS tanpa discectomy. Perbandingan perbedaan penurunan tinggi diskus antara kedua kelompok pasca 1 tahun operasi, menunjukkan perbedaan yang signifikan yaitu pada BESS discectomy dengan rerata 1,63 + 0,87 mm, sedangkan pada BESS tanpa discectomy sebesar 0,46 + 0,36 mm (p <0,001). Perbandingan terjadinya instabilitas tidak menunjukkan perbedaan yang bermakna antara kedua kelompok ( p=0,234)Diskusi dan Kesimpulan Prosedur BESS pada kasus DLCS memberikan penurunan skala nyeri NRS back pain dan leg pain yang sama baiknya pada kelompok BESS discectomy dan BESS tanpa discectomy. Tidak didapatkan perbedaan terjadinya instabilitas pada kedua kelompok, meskipun didapatkan perbedaan penurunan tinggi diskus yang signifikan antara kedua kelompok setelah 1 tahun operasi.

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Introduction Biportal Endoscopic Spine Surgery (BESS) is a minimally invasive method for decompressing nerve structures in Degenerative Lumbar Canal Stenosis (DLCS). This technique has advantages over other techniques in the preservation of soft tissue and posterior structures of the spine. The addition of a discectomy procedure to open surgery is known to cause a significant reduction in disc height, accelerate the degeneration process of the disc itself so that it will change the biomechanics of the vertebral segments and cause pain and even instability in the future. For this reason, research was conducted by comparing the clinical and radiological outcomes of DLCS performed by BESS with the addition of discectomy and without discectomy.

Materials and Methods This study took data from 48 DLCS subjects who met the inclusion criteria who had undergone the BESS procedure. Then divided into BESS discectomy group with 24 subjects and BESS without discectomy with 24 subjects using consecutive sampling. In each group, clinical outcomes were assessed in the form of the Numerical Rating Scale (NRS) pain scale and Oswestry Disability Index (ODI) scores pre and 1 year after surgery. Radiological outcomes were assessed in the form of disc height on standing lateral lumbar x-ray pre and post 1 year of surgery and the presence of instability was assessed from dynamic sagittal translation, dynamic sagittal angulation on standing dynamic lumbar x ray 1 year post surgery.

Results Of the 48 subjects in this study, the average age was 57.56+8.37, the majority were female 31 (64.6%), with the highest level of stenosis at L4-5 (64.6%), followed by L5-S1 at 25% and L3-4 10.4%. In the BESS discectomy group, there were significant differences in the NRS back and leg pain scales, ODI scores, and reduction in disc height pre and post-operatively 1 year (p<0.001), as well as in the BESS group without discectomy. Comparison of the difference in disc height reduction between the two groups after 1 year of surgery, showed a significant difference,in BESS discectomy with a mean of 1.63 + 0.87 mm, while in BESS without discectomy it was 0.46 + 0.36 mm (p <0.001 ). Comparison of the occurrence of instability did not show a significant difference between the two groups (p=0.234)

Discussion and Conclusion The BESS procedure in DLCS cases provided an equally good reduction in the NRS back pain and leg pain scales in the BESS discectomy and BESS without discectomy groups. There was no difference in the occurrence of instability in the two groups, although there was a significant difference in disc height reduction between the two groups after 1 year of surgery.

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"Pendahuluan: Skoliosis idiopatik remaja terbukti dapat menyebabkan masalah fisik, psikologis, dan sosial yang dapat mempengaruhi kualitas hidup setiap individu. Studi ini bertujuan untuk mengevaluasi factor faktor yang mempengaruhi kualitas hidup terkait kesehatan pada pasien skoliosis idiopatik.Metode: Studi potong lintang dilakukan pada dua rumah sakit tersier di Jakarta, Indonesia dengan menggunakan kuesioner Scoliosis Research Society-22 (SRS-22)dan Short Form (SF)-36. Subjek penelitian merupakan 80 pasien dengan skoliosis idiopatik remaja yang telah dioperasi dalam 5 tahun terakhir dengan minimum follow up selama 1 tahun. Data yang dianalis adalah jenis kelamin, usia, lokasi kurva, derajat keparahan (sudut Cobb), presentase koreksi, C7 plumb line, jumlah operasi, jumlah perdarahan, dan lama operasi.Hasil: Skor keseluruhan SF-36 adalah 94,5 (46,3-100) dan SRS-22 adalah 4,45 (3,58-4,84). Usia rata-rata subjek adalah 15 (10-26) tahun terdiridari 10% (n = 8) laki-laki dan 90% (n = 72) perempuan. Sembilan belas subjek (23,8%) memiliki skoliosis ringan (40°-60°), 41,3% sedang (60°-80°), dan 35% berat (> 80°). Presentase koreksi<50% ditemukan pada 30 (37,5%), 50-70% pada 39 (48,8%), dan> 70% pada 11 (13,8%) peserta. Lebih dari separuh peserta (57,5%, n = 46) berada dalam neutral balance dan 34 (42,5%) positive balance. Skor total SRS-22r memiliki perbedaan yang signifikan pada kelompok jenis kelamin (p = 0,026), C7 plumb line (p = 0,018) dan jumlah operasi (p =0,009). Skor total SF-36 memiliki perbedaan yang signifikan pada kelompok jenis kelamin (p = 0,019) dan C7 plumb line (p = 0,026). Selain itu, citra diri dan kepuasan yang merupakan sub-domain dari SRS 22 berkorelasi positif dengan C7 plumb line dan jumlah operasi.Pembahasan: Kualitas hidup terkait kesehatan pada pasien skoliosis idiopatik remaja yang dilakukan tindakan operasi menunjukan hasil yang baik. Pada studi ini, jenis kelamin, C7 plumb line, dan jumlah operasi berkaitan dengan kualitas hidup terkait kesehatan.Kualitas hidup terkait kesehatan pada skoliosis idiopatik remaja dipengaruhi oleh berbagai factor sehingga perlu dijadikan pertimbangan dalam target pengobatan setiap individu.

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Introduction: Adolescent Idiopathic Scoliosis (AIS) is a spinal deformity which may lead to physical and mental problems and can adversely affect patient satisfaction and the quality of life. The aim of this study is to evaluate the health related quality of life in scoliosis patients who had undergone surgical therapy.Methods: A cross sectional study was conducted in two tertiary hospital, Jakarta, Indonesia using Scoliosis Research Society-22 (SRS-22) and Short Form (SF)-36questionnaire. This study evaluated 80 AIS patients operated in our center over the past five years with a minimum follow up of one year. In addition, participant medical records were reviewed to collect data on gender, age, curve type, severity of scoliosis curve (Cobb Angle), the percentage of curve correction, C7 plumb line, number of operations, blood loss, and operative time.Results: The overall score of SF-36 is 94,5 (46,3-100) and SRS-22 is 4.45 (3.58-4.84). The median age of the participants was 15 (10-26) years. There were 10% (n=8) male and 90% (n=72) female. Nineteen participants (23.8%) had mild (40°-60°), 41.3 % moderate (60°-80°), and 35 % severe (>80°) scoliosis. The rates of curve correction<50% were found in 30 (37,5%), 50-70% in 39(48,8%), and>70% in 11 (13,8%) participants. More than half the participants (57,5 %, n=46) were in neutral balance and 34 ( 42,5 %) positive balance. The total score of the SRS-22r differed significantly between the groups of gender (p=0.026), C7 plumb line (p = 0.018) and number of operations(p = 0.009). The total score of the SF-36 differed significantly between gender (p=0.019) and C7 plumb line (p = 0.026). In addition, self-image and satisfaction, sub-domains of the SRS 22r, were positively correlated with C7 plumb line and number of operations.Discussion: The overall HRQoLof AIS patients who had undergone surgical therapy in scores in our population shows a good results. Gender, C7 plumb line, and number of operation were related to HRQoL scores of Indonesian adolescents with scoliosis. In addition, HRQoL in AIS patients can be affected by many factors which medical staff needs to consider in order to produce the best and most effective treatment outcomes."

"With the time available to surgeons-in-training ever dwindling, there is great emphasis placed on practical learning tools. Mirroring his earlier book on practical procedures in trauma surgery, Prof Giannoudis has produced a reference in more elective techniques. In most medical schools, most emphasis is placed on orthopaedic trauma surgery, with elective techniques often delayed until much later in a surgeon’s training."