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MANAGEMENT IN ELDERLY
ASEP NUGRAHA HERMAWAN
CURRICULUM VITAE
• Nama : Asep Nugraha Hermawan, dr. Sp.S
• Pekerjaan : Neurolog RSUD Sumedang
• Pendidikan :
• Dokter Umum Fakultas Kedokteran UNPAD 2005.
• Spesialisasi Neurologi Fakultas Kedokteran UNPAD 2015.
• The evidence for diagnostic accuracy of facet joint nerve blocks is good
• A criterion standard of 75% pain relief with ability to perform prior painful movements without
significant pain.
• Indications for therapeutic facet joint interventions are based on the diagnosis established with a
positive response to diagnostic blocks
• Therapeutic facet joint interventions the evidence is good for radiofrequency neurotomy in the
lumbosacral region
Laslett, 2006
SACROILIAC JOINT ARTHROPATHY
PROVOCATIVE TEST
Laslett, 2006
SACROILIAC JOINT ARTHROPATHY
PROVOCATIVE TEST
Laslett, 2006
SACROILIAC JOINT ARTHROPATHY
PROVOCATIVE TEST
Laslett, 2006
SACROILIAC JOINT ARTHROPATHY
• Conservative measures are considered first-line therapy for patients with SI joint
pain.
• If conservative measures fail to reduce the patient’s symptoms Therapeutic
Intervention
• For therapeutic sacroiliac joint interventions with intraarticular injections or
radiofrequency neurotomy, the joint should have been positive utilizing controlled
diagnostic blocks.
SACROILIAC JOINT INTERVENTION
• The best recommendation at this time is to use these injections as adjuncts to a
multimodal analgesia regimen with the understanding that it can likely help
patients in the short term (3 months) but evidence about its long-term (>3 months)
results is lacking.
• RadioFrequency ablation of the lower lumbar dorsal rami and S1–3(4) lateral
branches has been shown to provide pain relief lasting up to 1 year. (American
society of interventional pain physicians (ASIPP), 2013)
LOW BACK PAIN
LOW BACK PAIN WITH RADICULOPATHY
• Compression of nerve roots or spinal meninges by degenerated spinal structures (e.g., Herniated
discs, facet joints, hypertrophic ligamentum flavum)
LOW BACK PAIN
LOW BACK PAIN WITH RADICULOPATHY
• Studies specific to older adults are limited, but most include a wide range of age
groups
• There is general consensus that ESI provide at least short-term benefit (weeks to
months)
• ESI seem to provide some short-term pain relief and functional improvement and
should be considered as part of a pain treatment plan for older patients with low
back and/or leg pain.
LUMBAR EPIDURAL INJECTIONS
• The evidence for epidural steroid injection efficacy is strongest for short term relief of lumbosacral
radicular pain.
• The strongest evidence for trans-foraminal epidural steroid injection (TFESI) use is for relief of
unilateral lumbosacral radicular pain.
• The evidence suggests using inter-laminar epidural steroid injection (ILESI) in patients with bilateral
and/ or multi-level lumbosacral radicular pain.
• The data correlates efficacy of caudal epidural steroid injection (CESI) in low level bilateral or
multilevel lumbosacral radicular pain as well as in patients with history of lumbar surgery
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