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Low Back Pain(Nyeri Punggung Bawah)
RSU HAJI
SURABAYA
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Faktor Risiko
engangkat !e!an !erat !eru"ang#u"ang
$etaran
erokok %an &inu&an keras Sering &e"ahirkan
'urang aktiitas (inactie)
steo*orosis 'eturunan
'ece&asan %isertai %e*ressi
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Prea"ensi
eningkat !er%asar usia
+,- *a%a orang usia . /, thn0
+- %ari *en%u%uk *ertahun (1,,0,,,2thn) 3,- %ari *en%u%uk seu&ur hi%u*
'ronik LBP
Le!ih kurang +-
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Per"u *erhatian *a%a orang
tua
'arekteristik nyeri
A%anya tu&or2keganasan Riwayat *enyakit &e%is
Status *sikososia"
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Penye!a! LBP 4
Acute LBPLu&!ar strain or s*rain
5erte!ra" co&*ression 6racture karena
osteo*orosis
Aneuris&a aorta a!%o&ina"
Po"y&ya"gia rheu&atica
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'ronik LBPAging#re"ate% %egeneratie %isk an% 7oint
%isease8u&or
Penyakit Paget
Fi!ro&ya"gia9i66use i%io*athic ske"eta" hy*erostosis
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LBP
Nyeri *a%a kaki !erhu!ungan %engan
LBP
8rochanteric !ursitis
steoarthritis o6 the hi*
Lu&!ar cana" stenosis
Intererte!ra" %isk herniation
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:0 'arakteristik Nyeri
Lokasi "eg *ain . !ack *ain Suggests "u&!ar ra%icu"o*athy
Leg *ain &e&!erat %engan !er7a"an %an !er%iri ta*i
!erkurang %engan *osisi %u%uk s*ina" stenosis
Anterior thigh *ain u**er "u&!ar ra%icu"o*athy or hi*%isease
nset4 $ra%ua"; s"ow < %egeneratie &echanica" *ain
Su%%en an% seere < osteo*orotic co&*ression6racture0
=66ect o6 *ositiona" change 8i%ak !erkurang %engan *eru!ahan *osisi cancer
echanica" !erkurang %engan *eru!ahan *osisi
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>0 ?as*a%a th% @ancer @ancer
,0+- %ari LBP - LBP *a%a usia %iatas +,thn
3,- LBP *asien %g kanker *a%a usia 0 +,thn ?as*a%a4
Riwayat tu&or (0-) Nyeri yang konstant
Nyeri &a"a& hari yang &engganggu ti%ur(1,-)
Penurunan BB . :,C %a"a& !"n(:+-) LBP yang ti%ak !erkurang %engan *engo!atan
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@ancer (9eyo :133)
Sensitiity S*eci6icity
Age . +, ,0 ,0:
UneD*"aine%weight "oss (.+kgin /2:>)
,0:+ ,01E
Preious history o6cancer
,0: ,013
Not i&*roing with
&e%ica" care (:2:>)
,0: ,01,
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@ancer
Sensitiity S*eci6icity
No re"ie6 with !e%
rest
:0,, ,0E/
Insi%ious onset ,0/: ,0E>
9uration . :2:> ,0+, ,03:
Recent !ack in7ury ,0,, ,03>
8horacic *ain ,0: ,03E
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@ancer
>2 kasus kanker menimbulkan gejala LBP teruta&a4 *ayu%ara; *aru; gin7a" atau *rostate
u"ti*"e &ye"o&atersering Non s*ina" &a"ignant %iseases *resenting with
LBP Pancreatic carcino&a
Rena" ce"" cancer Intra*e"ic tu&ors Ly&*ho&a with retro*eritonea" "y&*ha%eo*athy
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Nuc"ear
e%icine
etastatic
Bone 9isease
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0 Non S*ina" e%ica"
@on%itions 9ia!etes a66ects :+- o6 a%u"ts . E+ y
Peri*hera" ascu"ar %isease
Risk o6 rena" toDicity 6ro& NSAI9s Ische&ic heart %isease an% @HF
At risk 6or rena" toDicity 6ro& NSAI9s
Una!"e to co&*"y with *hysica" thera*y
*rogra& Seere co&or!i%ity causing surgica" risk
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E0 Psychosocia" @on%itions
Stress *eker7aan 'e"ainan *siko"ogis
9e*ression AnDiety Su!stance a!use
Sosia" ekono&i
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8he Physica" =Da&ination
!serasi4S*ina" *osture (ky*hosis) %ue to erte!ra"
co&*ression Increase% &usc"e tone an% sti66ness
(unrecognie% ParkinsonGs %isease*resenting as !one *ain
Leg *ain a"ways check %ista" *u"ses (to%istinguish ascu"ar 6ro& neurogenicc"au%ication)
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Lu&!ar strain 2 s*rain(tersering)
2k 6aktor usia
At greater risk 6or stretch in7ury
Pain increase% with co&*ression 6racturesan% ky*hosis
Pain o6 a strain is usua""y acute !ut i6 %ue to
ky*hosis is usua""y gra%ua" with *ro"onge%
stan%ing; re"iee% in su*ine *osition
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5erte!ra" @o&*ression Fracture
8eruta&a *a%a wanita (osteo*orosis)
8er7a%i s*ontan atau %engan trau&a ringan
Nyeri akut %an &e&!erat %engan gerakan P"ain "atera" 6i"&s; Bone scan; or RI usua""y
%istinguishes acute 6ro& o"%er FDGs
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@o&*ression 6racture
Sensitiity S*eci6icity
Age . +, years ,03E ,0/:
Age . , years ,0>> ,01/
8rau&a ,0, ,03+
@orticosteroi% use ,0,/ ,011+
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Ra%iogra*h ("e6t) 5erte!ra" co&*ression 6racture
(arrow) in an e"%er"y *atient0 Bone scan (right
shows increase% u*take in the acute"y co&*resse%
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Po"y&ya"gia Rheu&atica
Nyeri ti!a#ti!a teruta&a &a"a& hari %ankekakuan *a% "eher; !ahu; *unggung %an*inggang
Usia . +,thn $iant ce"" arteritis 6oun% in E,- e&!aik %engan *engo!atan %engan
*re%nison (steroi%)
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9egeneratie %isk an% 7oint %isease
Sering
9iagnosis %engan RI or @8
@are6u" not to attri!ute LBP sy&*to&s tothese 6reuent"y asy&*to&atic an% near
uniersa" %egeneratie changes
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3/4/03
Exercise & Bed RestAdvice to stay active: Tere is no evidence tat advice to stay
active is arm!ul !or eiter acute lo" back#ain or sciatica$%
urt does not e'ual arm
(ne or t"o days o! bed rest i! necessary Ligt activity) avoiding eavy li!ting)
bending or t"isting *ie$ "alking+ ,o data on any #articular exercises
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Tera#i dan #encegaan
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3/4/03
-assage & Pysical Tera#y
Berman!aat
Perlu #enelitian lanjut karena banyak
sekali tenik massage
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3/4/03
Acu#uncture
.ata dan #enelitian masi sedikit
Belum bisa dibuktikan untuk tera#i LBP
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(ter -odalities
Back Brace/0orset/Lumbar 1u##ort:
Traction:
2njections: 2nconclusive evidence TE,1:
ot/0old:
3ltrasound:
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Pencegaan
Exercise:Aerobic) back/leg strengtening
Back braces and education about #ro#erli!ting tecni'ues are ine!!ective
4urangi BB dan mengindari merokok
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