BESAR KURVA THORAKAL DAN LUMBAL MODIFIER SEBAGAI FAKTOR PREDIKSI TERHADAP KOREKSI SPONTAN KURVA LUMBAL PASKA OPERASI PADA ADOLESCENT IDIOPATHIC SCOLIOSIS LENKE I

Anggita Tri Yurisworo, Bagas Widhiarso, Andhi Prijosedjati, Pamudji Utomo

DOI: https://doi.org/10.23917/biomedika.v11i2.7629

Abstract

Adolescent idiopathic scoliosis Lenke I dengan pola kurva mayor pada kurva thorakal (main thoracic), dengan kurva proximal thoracic dan thoracolumbar/lumbar sebagai kurva minor non struktural. Instrumentasi dan fusi hanya pada kurva thorakal dianjurkan. Pada literatur dijelaskan bahwa koreksi spontan kurva lumbal terjadi sebagai kompensasi untuk menyeimbangkan kurva thorakal setelah dilakukannya fusi thorakal selektif. Lumbal modifier dibagi menjadi 3 grup, pemilihan terapi operatif bergantung pada tipe lumbal modifier. Penelitian ini merupakan suatu analisis observational pada 35 pasien adolescent idiopathic scoliosis Lenke I paska operasi koreksi deformitas dan instrumentasi posterior. evaluasi menggunakan X ray sebelum dan setelah operasi untuk penentuan tipe lumbal modifier, besarnya koreksi kurva thorakal dan penilaian koreksi spontan kurva lumbal, kemudian dilakukan uji korelasi terhadap data yang didapat. Besarnya koreksi kurva thorakal terhadap koreksi spontan kurva lumbal paska operasi memiliki nilai signifikansi (Sig) = 0,000 < 0,05 dan besarnya koreksi kurva thorakal memiliki nilai koefisien regresi lebih besar bila dibandingkan dengan lumbal modifier terhadap koreksi spontan kurva lumbal paska operasi (variabel besar koreksi kurva thorakal (X1) = 0,764, Lumbal modifier (X2) = 0,092). Besarnya koreksi kurva thorakal berpengaruh signifikan terhadap koreksi spontan kurva lumbal paska operasi dan besarnya koreksi kurva thorakal yang paling dominan dalam mempengaruhi koreksi spontan kurva lumbal dibandingkan dengan lumbal modifier.

Kata kunci : Adolescent idiopathic scoliosis, Lumbal modifier, kurva thorakal

 

Adolescent idiopathic scoliosis Lenke I, main thoracic curve pattern has the major curve, with the proximal thoracic and thoracolumbar/lumbar being non structural minor curves. Thus, instrumentation and fusion of the main thoracic region alone is recommended. In the literature it is said that the lumbar curve spontaneously corrects to balance the thoracic curve after selective thoracic fusion. Most authors assumed a mechanism whereby improvement of the lumbar curve occurred through counterbalancing the surgical correction of the thoracic curve. The lumbar curve divided in three subgroups: lumbar modifier A, B and C. The selection of specific operative treatments depends on this modifier. This study was an observational analysis in 35 adolescent idiopathic scoliosis Lenke I patients after correction and posterior instrumentation surgery. Evaluation using X-rays before and after surgery to determine the type of lumbar modifier, the magnitude of the main thoracic curve and assessment of spontaneous lumbar curve correction, then correlation test obtained. The magnitude of main thoracic curve correction to the spontaneous lumbar curve correction has a significance value (Sig) = 0.000 < 0.05 and the magnitude of main thoracic curve correction has a greater regression coefficient than the lumbar modifier for spontaneous lumbar curve correction (large correction variable thoracic curve (X1) = 0.764, Lumbal modifier (X2) = 0.092). The magnitude of main thoracic curve correction has a significant effect on the spontaneous lumbar curve correction and the magnitude of main thoracic curve correction is most dominant factor to influence spontaneous lumbar curve correction compared to the lumbar modifier.

Keywords: Adolescent idiopathic scoliosis, Lumbar modifier, main thoracic

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