Spondilitis Tuberkulosa Cervical - Roni Eka Saputra; Irsal Munandar (Jurnal Kesehatan Andalas)
Abstrak Spondilitis tuberkulosa servikalis adalah penyakit yang cukup jarang dijumpai, hanya berkisar 2-3% dari seluruh kasus spondilitis tuberkulosa. Gambaran klinis sangat bervariasi, mulai dari gejala ringan dan tidak spesifik hingga komplikasi neurologis yang berat. Seorang wanita berusia 29 tahun datang dengan keluhan lemah keempat anggota gerak yang semakin memberat dalam 10 hari terakhir yang didahului oleh nyeri leher yang menjalar ke bahu dan lengan sejak 6 bulan sebelumnya. Nyeri awalnya dirasakan sebagai keterbatasan gerakan leher saat menoleh kesamping kiri dan kanan serta menundukkan kepala. Nyeri dirasakan semakin berat dengan pergerakan dan berkurang jika istirahat. Pasien mengalami penurunan berat badan sejak 2 bulan terakhir. Tidak dijumpai riwayat batuk atau nyeri dada. Pemeriksaan neurologis menunjukkan kelemahan  pada keempat ekstremitas. Hasil laboratorium ditemukan peningkatan Laju Endap Darah (LED). Rontgen foto toraks dalam batas normal. Roentgen foto cervical menunjukkan destruksi setinggi C5. MRI cervical menunjukkan destruksi pada korpus C5-6 dengan penyempitan pada discus intervertebrae C5-6 disertai dengan  massa/abses paravertebral dengan penekanan ke posterior. MRI Thorakal tampak destruksi corpus verebre T4,5 dengan diskus intervertebralis yang menyempit. Sugestif suatu spondilitis tuberkulosa. Pasien dilakukan tindakan pembedahan anterior corpectomi melalui microscopic surgery dengan graft dari iliac sinistra, serta insersi anterior plate 1 level. Hasil pemeriksaan patologi anatomi menunjukkan spodilitis TBC kaseosa. Pada spondilitis vertebre T4,5 dilakukan laminectomi, debridement costotrasversektomi, dan stabilisasi dengan pedicle screw T2, T3, dan T5. Pasien diterapi dengan obat antituberkulosis. Keadaan pasien saat ini, pasien sudah bisa beraktifitas normal dengan motorik dan sensorik baik. Spondilitis tuberkulosa merupakan bentuk tuberkulosa tulang yang paling sering dijumpai. Spondilitis tuberkulosa cervical berkisar 2-3% kasus spondilitis tuberkulosa. Keterlibatan spinal biasanya merupakan akibat dari penyebaran hema Kata kunci: spondilitis TB, cervical, pembedahan   Abstract Cervical tuberculous spondylitis is a fairly rare disease, only about 2-3% of all cases of tuberculous spondylitis. The clinical features vary widely, ranging from mild and non-specific symptoms until the fatal neurological complications. A 29-year-old woman came with a complaint weakness of the four limbs become heavy in the last 10 days, were preceded by neck pain that radiates to the shoulders and arms since 6 months earlier. Pain was initially perceived as a limitation of neck movement when turned to the left and right side, and bowed his head. Perceived pain exacerbated by movement and reduced if the rest. Patients lost weight since the last 2 months. Found no history of cough or chest pain. Neurologic examination showed weakness in four extremities. Laboratory results found increased Erythrocyte Sedimentation Rate (ESR). X-ray radiographic normal. Cervical x-ray photograph shows destruction as high as C5. MRI shows destruction in the corpus C5-6 with narrowing at C5-6 intervertebre disc  accompanied by paravertebral abscess with emphasis to the posterior. Found destruction corpus verebre T 4.5 with intervertebral disc narrowing. Suggestive of a tuberculous spondylitis. At 5.6 C spondylitis vertebre anterior corpectomi following surgery, microsurgery with iliac graft, and insertion one level anterior plate. Anatomical Pathology examination showed caseating tuberculosis spodilitis. At T 4.5 vertebre spondylitis done laminectomi, costotrasversektomi debridement, and stabilization with pedicle screw T2, T3, and T5. Patients also treated with anti-tuberculosis drugs. Present status, patient is able to perform daily activity with sensoric and motoric good. Tuberculous Spondylitis is the most common form of tuberculosis that affect the bone. Cervical Tuberculous spondylitis ranges from 2-3% of cases of tuberculous spondylitis. Spinal involvement is usually the result of hematogenous spread ekstraspinal lesions. Diagnosis is based on history, clinical and radiological feature. Treatment consists of antituberculosis drug with or without surgical intervention. The patient treat surgical intervention and anti-tuberculosis drug. Present status, patient is able to perform daily activity with sensoric and motoric good. Keywords:spondilitis TB, cervical, Surgery