Peran Steroid dalam Tatalaksana Trauma Medula Spinalis Akut: Sebuah Laporan Kasus

Abstract

Pendahuluan: Trauma medulla spinalis merupakan kedaruratan neurologi yang memerlukan tindakan cepat tepat karena berdampak kecacatan dan tingginya angka kematian. Mortalitas akibat trauma medula spinalis mencapai 48% dalam 24 jam pertama. Gejala lesi medulla spinalis dapat berupa gangguan motorik - sensorik ekstremitas dan gangguan otonom. Semakin tinggi lokasi lesi medulla spinalis, semakin berat disfungsi yang terjadi.

Deskripsi kasus: Seorang pria berusia 45 tahun mengalami kelemahan kedua tungkai sejak 3 jam lalu akibat kecelakaan lalu lintas, mobil yang dikendarai pasien terperosok dalam jurang. Kelemahan tungkai disertai hipoestesi setinggi medulla spinalis Vertebrae Lumbal 2, inkontinensia urin, dan inkontinensia alvi. Pada pemeriksaan foto X-Ray Torakolumbal didapatkan kesan fraktur kompresi Vertebrae L2 (Burst Fracture), tulang vertebrae lumbosacral lainnya intact. Manajemen pada kasus ini adalah tirah baring, monitor tanda vital, pemberian metilprednisolon high dose, pencegahan komplikasi, dan fisioterapi. Selama pemantauan, terdapat perbaikan fungsi motorik dan otonom. Berdasarkan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang ditegakkan diagnosis sebagai paraplegi UMN dan hipoestesi setinggi myelum Vertebrae Lumbal 2, disertai inkontinensia urin et alvi akibat trauma medulla spinalis komplit.

Kesimpulan: Manajemen trauma medulla spinalis bertujuan meningkatkan dan mempertahankan fungsi sensorik dan motorik. Manajemen cepat sangat penting untuk mencegah dampak kerusakan lanjut dan meminimalisir defisit neurologis. Trauma medula spinalis komplit apabila tidak menunjukkan perbaikan dalam 72 jam pertama, cenderung menetap dan prognosis buruk.

Background:  Spinal cord injury (SCI) is a neurological emergency that requires appropriate action because the impact on disability and high mortality rate. Mortality reaches 48% in the first 24 hours due to SCI. Clinical manifestation include motor-sensory deficit of extremities and autonomic deficit. The higher lesion of spinal cord, the dysfunction will be more severe.

Case Description: A 45-year-old man has experienced weakness in both legs since 3 hours ago due to an accident, the patient's car fell into a ravine. Patient has leg weakness with hypoesthesia at the L2 vertebrae, urinary and alvi incontinence. Based on X-Ray examination of thoracolumbar spine, there was compression fracture of the L2 vertebrae (burst fracture), the other vertebrae was intact. Management of this case were bed rest, vital sign monitoring, high dose methylprednisolone, complication prevention, and physiotherapy. During hospitalized, there was improvement in motoric and autonomic function. Based on the history, physical examination and imaging, the diagnosis was paraplegia and hypoesthesia at 2nd Lumbar Vertebrae, accompanied by urinary-alvi incontinence due to complete SCI.

Conclusion: Management of SCI was aimed to improve sensory and motor function, it has a role to prevent further damage and minimize neurologic deficits. If the complete spinal cord injury does not show improvement in the first 72 hours, it tends to persist and has poor prognosis.