Laporan kasus :

kepada Yth : Rencana disajikan tgl : 23 11 2000

HERNIA NUCLEUS PULPOSUS (HNP) LUMBAL

OLEH : SULISTYONO

BAGIAN / SMF ILMU PENYAKIT SARAF FK UNDIP / RSUP dr KARIADI SEMARANG 2000

HERNIA NUKLEUS PULPOSUS (HNP) LUMBAL Penda !"!an Iskhia !ia a"a ah p#rasaan n$#ri $an! "i%a arkan (n$#ri ra"iku #r) s#pan%an! n iskhia"ikus "an &a'an! &a'an!n$a "i s#'# ah "is(a ) Si*a( n$#ri $an! (#!as "an k#ras "irasakan pa"a "#r+a(o+ (#r(#n(u pa"a p#r+ukaan ku i() Ha ini o #h kar#na (#ran!san!n$a s#ra'u( s#ra'u( sara* $an! +#+'#n(uk N Iskhia"ikus, p#ran!san!an (#rs#'u( "apa( (#r%a"i pa"a ra"iks a(au p #ksus u+'o sa&ra a(au N iskhia"ikus (p#ri*#r) i(u s#n"iri, sa ah sa(u p#n$#'a' iskhia !ia a"a ah H#rnia Nuk #us Pu posus (HNP)) H#rnia Nuk #us Pu posus (HNP) a"a ah h#rniasi - +#non%o n$a s#'a!ian nuk #us pu posus k#"a a+ kana is .#r(#'ra is aki'a( "ari !a$a ko+pr#si $an! +#n"a"ak pa"a /iskus In(#r.#r(#'ra is $an! &ukup kua( un(uk +#+u(uskan s#ra'u( s#ra'u( Anu us 0i'rosus, s#hin!!a akan +#n#kan %arin!an p#ka n$#ri +isa n$a i!a+#n(u+ on!i(u"ina # pos(#rior, ra"iks n#r.i spina is " ) 0ak(or *ak(or (a+'ahan $an! pa in! p#n(in! a"a ah p#ru'ahan "#!#n#ra(i* "an hi an!n$a # as(isi(as "ari Anu us 0i'rosus, s#hin!!a anu us *i'rosus (i"ak "apa( a!i +#nahan !a$a ko+pr#si $an! +#n"a"ak "ari .#r(#'ra $an! s#'# u+n$a "apa( "i(o #ransi) Ge#a"a dan $anda % HNP s#&ara (#ori(is "apa( (#r%a"i k#s#!a a arah, (#(api pa"a k#n$a(aann$a han$a a"a 1 arah sa%a $an! +#+'#rikan +ani*#s(asi k inis $ai(u k# arah : 1) P&'$er& 'en$ra" : $an! +#n!aki'a(kan n$#ri pin!!an! o #h kar#na +#n#kan i!a+#n(u+ on!i(u"ina is pos(#rior) 1) P&'$er& "a$era" : +#n!aki'a(kan n$#ri pin!!an!, !#%a a "an (an"an$a '#r'#"a s#suai "#n!an ra"ik $an! (#r!#n!!u) /a#rah Lu+'a +#rupakan (#+pa( $an! pa in! s#rin! (#r%a"i HNP, "an 'iasan$a +# i'a(kan "iskus L2 3 L4 a(au L4 3 S1 , 5a aupun #si #si pa"a #.# u+'a $an! ain (#r%a"i #'ih s#"iki( "an s#rin! (#r"apa( Pro(usi Mu (ip# ) D(a)n&'(' %

Un(uk "apa( +#n#!akkan "ia!nosis HNP Lu+'a "ip#r ukan "a(a $an! "ip#ro #h "ari : I. II. Ana+n#sis) P#+#riksaan k inis u+u+ : a. Pa"a posisi '#r"iri apakah (a+pak sko iosis, hip#r or"osis, sikap a'nor+a ) b. Pa"a posisi (#r #n(an! "ip#r ukan (#s (#s s#'a!ai '#riku( : 1) T#s un(uk +#r#!an!kan N Is&hia"ikus : 6 T#s Las#!u# (s(rai!h( #! risin! 7 SLR)) 6 T#s Las#!u# +#n$i an!) 1) T#s un(uk +#naikan (#kanan in(ra (#ka : 6 T#s 8a sa.a) 6 T#s Na**9i!#r :) 2) T#s un(uk +#+'an!ki(kan n$#ri pa"a s#n"i pan!!u : 6 T#s Pa(ri&k) T#s un(uk +#+'an!ki(kan n$#ri pa"a s#n"i Sakroi iaka) 6 T#s Kon(ra Pa(ri&k) &) Pa"a posisi (#n!kurap $an! p#r u "ip#riksa a"a ah : 1) Apakah a"a "a#rah a(au (#+pa( $an! n$#ri (#kan) 1) 0#+ora N#r.# S(r#(&h T#s( (0NST)) III) P#+#riksaan N#uro o!is) a) P#+#riksaan Mo(orik : 1) K# #+ahan o(o( (#r(#n(u) 1) A(ro*i) :) 0asiku asi) /#n!an +#n!#(ahui a"an$a k# u+puhan pa"a o(o( (#r(#n(u, +aka akan "ik#(ahui ra"iks +ana $an! (#r!an!!u) ') P#+#riksaan "#*isi( S#nsorik , "#n!an +#n!#(ahui "#r+a(o+ +ana $an! (#rk#na, akan "ik#(ahui pu a ra"iks $an! (#r!an!!u)

&) P#+#riksaan r#* #ks, 'i a a"a k# ainan pa"a r#* #ks (#n"on, ini '#rar(i a"a !an!!uan pa"a #n!kun! r#* #kn$a) I8) P#+#riksaan P#nun%an!) 1) P#+#riksaan EM; : /#n!an p#+#riksaan EM; "apa( "i(#n(ukan : 6 Ra"iks +ana $an! (#rk#na) 6 S#%auh +ana !an!!uan $an! (#r%a"i, apakah +asih "a a+ (ara* iri(asi a(au su"ah a"a ko+pr#si) 1) P#+#riksaan Ra"io o!is) 6 < 0o(o po os .#r(#'ra Lu+'osakra AP - L - O' i= kanan "an kiri) 6 P#+#riksaan kau"o!ra*i) :) Pun!si Lu+'a , harus "ip#rha(ikan : a) Apakah a"a ha+'a(an a iran L>S 6 K#&#pa(an a iran L>S s#'# u+ "an s# a+a "i akukan (#s ?u#&k#ns(#"() 6 In"#ks A$a a) ') Apakah a"a k#naikan ka"ar pro(#in "a a+ L>S) &) Apakah a"a s# pa(o o!is "a a+ L>S) 8) P#+#riksaan La'ora(oriu+) P#+#riksaan a'ora(oriu+ harus "is# #ksi +#nuru( k#p#n(in!ann$a, un(uk +#n$in!kirkan "ia!nosis 'an"in!) /ia!nosis Ban"in!) P#n$aki( ain $an! +#ni+'u kan Is&hia !ia an(ara ain : 1) N$#ri pin!!an! +#kanik aku( a(au kronik) 1) N$#ri pin!!an! or!anik : a) N$#ri pin!!an! or(o!#nik : pros#s pa(o o!is "i 8#r(#'ra : 6 Ra"an! : Spon"i i(is TB>) 6 Trau+a : 0rak(ur .#r(#'ra u+'a ) 6 K#!anasan : pri+#r (+u (ip # +i# o+a), s#kun"#r (+#(as(as#)) 6 Kon!#ni(a : Sko iosis)

') N$#ri pin!!an! "isko!#nik : Pros##s pa(o o!is "i "iskus: Spon"i osis Spon"i osis anki osa HNP &) N$#ri pin!!an! n#uro!#nik : pros#s pa(o o!is "i kana is spina is, +isa n$a : Ara&hnoi"i(is, Tu+or "a a+ kana is spina is, S(#nosis spina is) ") N$#ri ru%ukan@ k# ainan "i"a a+ ron!!a pan!!u , +isa n$a : p#ru(, r#(rop#ri(on#a "apa( +#+'#rikan ru%ukan n$#ri k# "a#rah u+'o sakra "an sakroi iaka) #) N$#ri pin!!an! psiko!#nik@ (i"ak +#+pun$ai "asar or!anik, (i"ak %aran! n$#ri pin!!an! ini (#r%# +a a(as k#in!inan pasi#n un(uk +#+p#ro #h k#un(un!an s#kun"#r) Pen)&*a$an % 1) Kons#r.a(i* : "i'#rikan o'a( si+p(o+a(is, +is ana !#(ik, +us& # r# aksan, (ran=ui i9#r +inor ka au p#r u, n#uro(ropik .i(a+in) 1) Op#ra(i* : apa'i a "#n!an kons#r.a(i* !a!a , s# a u (#r%a"i k#ka+'uhan- saki( $an! san!a( h#'a( "an (#r"apa( "#*isi( n#uro o!is '#rupa !an!!uan +iksi "an "#*ikasi) :) R#ha'i i(asi +#"is)

KEPUSTAKAAN 1) Rahar"%o R, A#pi(an Sara* "an K# u+puhan, "a a+ Simposium Gangguan Gerak, S#+aran!, Ba"an P#n#r'i( Uni.#rsi(as /ipon#!oro, 1BBC@ 1D4 3 111) 1) Mar"%ono M, Si"har(a P, Neurologi Klinik asar! PT /ian Rak$a(, 1BEB,B:) :) Hin(on > Ri&har", Ba&ka&h#, in "anual o# Neurologic $herapeutics #" Sa+u# s A Mar(in, 4(h #", Li( # Bro5n an" >o+pan$, Bos(on, 1BB4 : FE 3 EE) 2) Gira5an, N$#ri Pin!!an!, Si+posiu+ N$#ri, 0K UN/IP, Ba"an P#n#r'i( 0K UN/IP, S#+aran!, 1BB1) 4) No#%an(o M, N$#ri Pin!!an! S#'a!ai ;an!!uan N#uro+usku osk# #(a pa"a Usia Lan%u(, Ba"an P#n#r'i( UN/IP, S#+aran!, 1BB:@ CE 3 E1)

LAPORAN KASUS

1) I/ENTITAS PEN/ERITA Na+a U+ur P#k#r%aan A a+a( R#!is(#r : E M Roha$a"i) : 44 (h : ;uru S/ : Pan"an haru+ 3 ;ro'o!an H Pur5o"a"i : D:BBDF

1) ANAMNESIS) Ke"! an !$a+a : N$#ri pin!!an! kiri $an! "i%a arkan sa+pai (un!kai kiri R(,a-a$ .en-a/($ 'e/aran) : (ana+n#sa (! 1B 3 11 3 1DDD) 4 'u an $an! a u ( 1C %u i 1DDD) k#(ika s#"an! +#n!an!ka( '#ras (i'a (i'a pin!!an! kiri (#rasa saki(, s#%ak saa( i(u s#rin! (#rasa saki( pin!!an! kiri (#rasa k#+#n! "an s#p#r(i k#s#+u(an $an! "i%a arkan sa+pai (un!kai s#'# ah kiri, 'i a '#rsin, 'a(uk n$#ri '#r(a+'ah parah, 'i a '#r%a an %a an I 4 +#ni( su"ah (i"ak (ahan saki(n$a, pa"aha p#k#r%aann$a +#n!a%ar %a"i harus s# a u '#r%a an - '#r"iri "i+uka k# as, saki( "i%a arkan k# (un!kai 'a5ah "is#r(ai rasa #+ah "an k#s#+u(an "i "a#rah %#+po "an kaki kiri, BAB "an BAK nor+a , 'i a naik (an!!a n$#ri '#r(a+'ah h#'a(, "an +#n!uran! apa'i a un(uk is(iraha( ( posisi (i"ur (#r #n(an! "#n!an u(u( "i(#kuk )) Su"ah p#rnah "ipi%i( o #h "ukun uru( (#(api saki( '#r(a+'ah, "io'a(kan k# RSU Pur5o"a"i "iru%uk k# Po i Sara* RS/K k# PRU su"ah +#n%a ani (#rapi p#n$inaran "an "i(raksi s#'an$ak 14 ka i su"ah +#n"apa(kan s#pa(u kor#ksi "an kors#( pin!!an!) R(,a-a$ .en-a/($ da !"!

P#n"#ri(a 'aru p#r(a+a ka i saki( s#p#r(i ini, ri5a$a( (rau+a s#'# u+n$a "isan!ka , ri5a$a( p#n$aki( 'a(uk a+a "isan!ka ) R(,a-a$ .en-a/($ /e"!ar)a0 Ti"ak a"a k# uar!a $an! +#n"#ri(a saki( s#p#r(i ini) R(,a-a$ '&'(a" e/&n&+(0 P#n"#ri(a a"a ah s#oran! PNS (!uru) is(ri '#k#r%a s#'a!ai p#"a!an! k#&i , anak : oran! s#+ua +asih ku iah, k#!ia(an s#hari hari "i s#ko ah, k#!ia(an #ks(ra '#r&o&ok (ana+, 'ia$a "i(an!!un! ASKES :) PEMERIKSAAN 0ISIK) KU 'aik, koop#ra(i*, !i9i 'aik) Tan"a .i(a @ T 1:D-ED ++H!, N F1 < - +#ni( RR 12 < - +#ni( S(a(us In(#rnus : "'n S(a(us N#uro o!ikus Nn Krania is : "'n P#+#riksaan Trun&us : Pun!!un! : Insp#ksi : !i'us (H), (an"a ra"an! (H), sko iosis (I) Pa pasi : Spas+# o(o( para .#r(#'ra L2 3 4 kiri (I) N$#ri (#kan para .#r(#'ra L2 3 4 kiri (I) N$#ri (#kan "a#rah in*rapiri*or+is kiri (I) N$#ri (#kan s#pan%an! p#r%a anan n Is&hia"ikus kiri (I) ;#rak : 24o - :Do :DD - :DD 24D - 24D N$#ri !#rak I - H H - I H - I An(# - r#(ro* #ksi La(#ro* #ksi Ro(asi k# ka - ki EJ(r#+i(as in*#rior : P#r'#"aan pan%an! (un!kai ka 7 EE &+ , ki 7 B1 &+ Mo(orik ka ki

ROM (I) (#r'a(as kar#na n$#ri

;#rak K#kua(an : * #ksi hip Eks(#nsi u(u( /orso* #ksi ank # /orso* #ksi i'u %ari P an(ar * #ks ank # Tonus R#* #k *isio o!is u(u( R#* #k *isio o!is (u+i( R#* #k pa(o o!is

N 4 4 4 4 4 N N N 4 4 4 2 2 N N

S#nsi'i i(as : par#s(#si s#suai "#n!an "#r+a(o+ L4 H S1 8#!#(a(i* : BAN "an BAK "'n) T#s pro.okasi : Las#!u# Pa(ri&k Kon(ra Pa(ri&k T#s 0NST T#s .a sa.a T#s Na*9i!#r T#s as#!u# si an! P#+#riksaan (a+'ahan : < *o(o u+'osakra : P#n$#+pi(an pa"a 8L 2 3 4 S1 EM; : po ira"iku opa(i sinis(ra rin!an) ;an!!uan A/L : () ASSESMENT : /K : Is&hia !ia sinis(ra /T : Ra"iks L4 S1 /E : Susp HNP Lu+'a is) (I) (I) (I) BDo 24D

TERAPI : 1) M#"ika+#n(osa) 1) R#ha'i i(asi

PRO;RAM REHABILITASI ME/IK) 1) 0isio(#rapi : P#+#riksaan : Kon(ak, p#n!#r(ian "an ko+unikasi : 'aik, n$#ri (#kan para .#r(#'ra "a#rah pin!!an! (I), n$#ri !#rak pin!!an! (I), n$#ri +#n%a ar s#pan%an! n Is&hia"ikus (I), (#s as#!u# (I), SLR 24 D, sko iosis (I), ROM pin!!an! (#r'a(as, ROM Pro!ra+ : u(u( "'n, k#kua(an o(o( : * #ksi hip (4), #ks(#nsi u(u( (4), * #ksi ank # (4)) +#n!uran!i n$#ri, SG/, (raksi u+'a , Ba&k EJ#r&is#, hi"ro (#rapi, +#+# ihara ROM (un!kai, +#na+'ah ROM ko .#r(#'ra is, +#+# ihara k#kua(an o(o( (un!kai, +#+p#r'aiki sko iosis, +#n%a!a pos(ur (u'uh 5ak(u '#r%a an) E"ukasi : 1) Okupasi (#rapi) P#+#riksaan : P#n!#r(ian, ko+unikasi (I), +akan, +inu+ (I), n$#ri (#kan pin!!an! (I), n$#ri !#rak (runkus K (un!kai kiri (I) k#(ahanan "u"uk "'n, k#(ahanan '#r"iri , AKS pri'a"i : k#(ahanan '#r"iri , AKS p#k#r%aan k#(ahanan '#r"iri Pro!ra+ : :) Sosia +#"ik : P#+#riksaan : P#n"#ri(a s#oran! PNS, is(ri '#r"a!an!, anak : su"ah ku iah s#+ua, 'ia$a p#n!o'a(an "i(an!!un! ASKES, a(ihan k# PRU %auh) P#n!ua(an o(o( pin!!an!, (un!kai "an o(o( p#ru(, +#nin!ka(kan k#(ahanan '#r"iri "an '#r%a an, PBM, ho+# (rainin!) M#n%a!a '#ra( 'a"an)

Pro!ra+ :

M# akukan kun%un!an ru+ah

k#a"aan ru+ah K !#o!ra*is

n$a, +#+'#rikan p#n%# asan (#n(an! p#n$aki(n$a, +#n!a%ak par(isipasi ak(i* k# uar!a un(uk a(ihan p#n"#ri(a, p#n"#ka(an "#n!an a(asan %#nis p#k#r%aan $an! +#+un!kinkan 2) Psiko o!i P#+#riksaan : P#n!#r(ian, kon(ak 'aik, (a+pak &#+as (#n(an! p#n$aki(n$a) Pro!ra+ : Mo(i.asi a(ihan ru(in, +o(i.asi k#pa"a k# uar!a un(uk '#r par(isipasi ak(i* "a a+ a(ihan p#n"#ri(a 4) Or(o(ik pros(#(ik) P#+#riksaan : kon(ak K p#n!#r(ian 'aik, +#+'un!kuk n$#ri (I), +irin! n$#ri (I), k#(ahanan '#r"iri , pan%an! (un!kai '#r'#"a I 2 &+) Pro!ra+ : M#nun!!u hasi 0isio(#rapi, p#+akaian spina 'ua(an s#pa(u kor#ksi) C) T#rapi 5i&ara) P#+#riksaan : p#n"#n!aran, 'i&ara 'aik Pro!ra+ : () kors#(, p#+

1D