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N EGLECTED SPINE CASES FROM KALIMANTAN

N EGLECTED SPINE CASES FROM KALIMANTAN. Zairin noor MD.,Ph.D. Faculty of medicine Lambung Mangkurat. Ulin General Hospital. Banjarmasin, South Kalimantan INDONESIA. South Kalimantan Capital  Banjarmasin 36,985 km² citizen  3,790,071 (2012) orthopaedic surgeon : 8

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N EGLECTED SPINE CASES FROM KALIMANTAN

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  1. NEGLECTED SPINE CASES FROM KALIMANTAN Zairin noor MD.,Ph.D Faculty of medicine Lambung Mangkurat. Ulin General Hospital. Banjarmasin, South Kalimantan INDONESIA

  2. South Kalimantan Capital  Banjarmasin36,985 km²citizen  3,790,071 (2012)orthopaedic surgeon : 8 1 Spine surgeon 1 Hand surgeon 1 Recons surgeon 5 Ortho surgeon  1 : 473,758 • Centre Kalimantan capital  Palangka Raya 157,983 km² citizen  2,514,375 (2012) orthopaedic surgeon : 2  1 : 1,257,188

  3. Case 1 • Male, 27 yo • Neglected SCI due to fracture dislocation at 12ththoracal – 1st lumbar vertebrae Frankel A • Laminectomy and posterior stabilization

  4. 5o 25o

  5. Case 2 • Female, 40 yo • Neglected SCI due to burst fracture of 12ththoracal vertebrae Frankel A • Laminectomy + corpectomy + posterior stabilization

  6. 25o 4o

  7. Case 3 • Male 39 yo • Neglected Spinal cord injury complete lesion due to unstable burst fracture dislocation at level of 12th thoracal vertebrae-1st lumbal vertebrae frankel A

  8. 14o 0o

  9. Case 4 • Mr. S, 33 yo • Spinal cord injury due to burst fracture Vth 5-6 frankle D

  10. 35o 22o

  11. Case 5 • Mr. A • Spinal Cord Injury at the level of 1st Lumbal vertebrae due to fracture dislocation at the level of 1st Lumbal Vertebrae

  12. 26o 20o

  13. Spine Surgery (2006-2013)

  14. Neglected Spine Trauma Cases • Operatif Spine of Neglected trauma 2006 – 2013 : 91 cases • With neurologic defisit : 80 (87.91 %) • Frankel A : 62 (77,50%) • Frankel B : 5 (6,25%) • Frankel C : 7 (8,75%) • Frankel D : 6 (7,50%) • Without neurologic defisit : 11 (12.09 %)

  15. Is Early Decompression of Traumatic SCI Safe ? • Late Surgery ? • Defined > 24 hrs, > 72 hrsto > 5 days - Early surgical Intervention in the setting of acute SCI is SAFE and be associated with reduced LOS and possibly reduced pulmonary complications 9 Papers reviewed 1994-2006. Human SCI Trials

  16. Efficacy of Surgical Decompression in regard to motor Recovery in the SCI • Retrospective cohort sudy : • 91 Patients with SCI - 6-8 Mean days to surgery • Improvement • SCI:20 % • Bladder : 40 % • No correlation between degree of improvement and timing of surgery

  17. Neglected spine trauma cases • Patient factors • System factors

  18. Neglected Fracture • Latin  neglectus • First Known Use: 1529 transitive verb 1:to give little attention or respect to :disregard 2:to leave undone or unattended to especially through carelessness -Merriam Webster Dictionary -

  19. Neglect I : results are the same regardless the time II : results are not the same  need more action to achieve good result III : operation or not  malfunction of limb IV : Useless limb : need to do amputation procedure -- Soelarto --

  20. Reasons • Financial problems • Affraid to face doctors • Compliance to bone setter is still higher • Geografis  distance  lack of health facilities

  21. Islah Khairulah (banjarmasin, 2011) • there is correlation between level of education, employement and income of patients with time of medical seeking (p> 0,05) • Visite to bone setter is one of the way to get treatment

  22. So when do these spine fractures need to be treated ?

  23. Neurological Deficit : • Any patients with a progressive neuro deficit • Any patient with inability to functionally mobilize : - Increasing likelihood of complications from recumbency : • - PE • - DVT • - Pneumonia

  24. Deformity ? • This area becomes the most gray….. - Are we treating the source of the pain ? Osteoporotic burst fracture ? Deformity ? Both ? -Are we attempting to treat a problem that may worsen with time ?

  25. Methods to Improve fixation • Approach • Points of fixation • Intrumentation Changes • Decompression • Fusion Technique

  26. Surgical Decision GOALS • Optimize Neurological Recovery - Decompressio of Spinal Cord - Obtain Spinal Stability - Biological Fusion - Minimize Morbidity

  27. Conclusion • Operative Treatment : • Neurological deficit • Inability to mobilize/Ambulate despite non-op • Balance risk factors for intrumentation related complication : screw Augmentation, Increased levels,Anterior column support • Non Operative Treatment: • Neurologically intact • Pain but able to mobilize • Significant Medical Co-morbities • Watch & observe the patient : See if the deformity progressives, See if pain increased

  28. Take home message • neglected cases depend on many factors : Treatment must be discuss clearly to know the expectation of the patient,the procedure/ operations and realistic results that can be achieve

  29. SAVE OUR FOREST Thank You

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