Orthopaedic Mount Elizabeth Singapore

5 Facts Parents Should Know About Scoliosis

September 30, 2019 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

80% of all scoliosis occur during adolescent. This type of scoliosis is called Adolescent Idiopathic Scoliosis. Sometimes, parents and doctors face challenges in treating teenagers. They are undergoing psychological changes to find their identity. They may refuse to accept that they have scoliosis. They may also refuse treatment. This can cause anxiety in the parents.

Here is the 5 things parents need to know about scoliosis.

Scoliosis Needs Regular Follow-Up. Scoliosis tends to get worse as the child is growing. Regular follow up is required to monitor the progression of the scoliosis. When there is no more growth and the scoliosis is stable after serial X-rays, follow-up is no longer required.
Scoliosis Get Worse but Cannot Get Better. But parents don’t need to be alarmed. No treatment modalities other than surgery can reduce the severity of scoliosis. It doesn’t mean that surgery needs to be done for all cases of scoliosis. Brace can be useful to slow down the progression of the scoliosis (not to reduce the severity). You need to be careful if someone promise they can do something to reduce the severity of scoliosis. It is safe to leave the mild scoliosis alone without specific treatment. Children can live normal lives with mild scoliosis.
Scoliosis Is Not Caused by Heavy Schoolbag. The cause of Adolescent Idiopathic Scoliosis is unknown. Although carrying a heavy schoolbag is not good for the growing spine and can cause other problems, it is not the cause of scoliosis. Sporting activities, injury or wrong sitting posture also are not the cause of scoliosis.
Not All Scoliosis Need Treatment. A very mild scoliosis in growing children or scoliosis that does not progress during adulthood does not need any specific treatment other than follow up. Only 30% of scoliosis need bracing and only 10% of scoliosis need surgery.
If Surgery Needed, The Earlier The Better. Surgery is required for severe deformity. The risks of surgery increase with the degree of the severity of the curves. Therefore, it is best to do scoliosis surgery earlier than later if it is required.

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

Problem in Your Buttock Can Cause Low Back Pain

June 4, 2018 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

80% of the population suffer from low back pain at least once in their life time. Sometimes, low back pain is caused by injury to the muscles, joints or the discs in the lumbar region. Other time, it is related to subtle wear and tear changes that cause gradual wearing down of the cartilage or the disc.

When there is significant pain in the buttock, it may be originating from the sacroiliac joint which is a joint that connects the spine and the hip bones. Sacroiliac joint is a common cause of low back pain. However, the diagnosis may not be obvious and often requires thorough physical examination.

There are two sacroiliac joints, one on each side of the spine. These joints transfer the weight of the upper body to the lower limbs. This joint operates under tremendous strain during activities like running, jumping and sitting. Unlike the knee joint which wide range of motions, sacroiliac joint has a very little movement.

Problem in Your Buttock Can Cause Low Back Pain

Anatomy of sacroiliac joint

Problems related to the sacroiliac joint is called Sacroiliac Joint Dysfunction (SIJ dysfunction). It affects both men and women but women tend to get it more. The ligaments stabilising the sacroiliac joint become lax during childbirth causing it to be prone to injury.

Apart from injury, weak muscles surrounding the joint are often the cause of SIJ dysfunction. If this is not addressed, the pain persists and becomes chronic. The nerves supplying the joint constantly send pain signal to the brain causing discomfort. Sometimes, the pain signal process continues independently of the original issue. This means after all identifiable problems are addressed, the pain can still persist.

People with SIJ dysfunction complain of low back pain very close to the buttock. It can affect one side or both sides of sacroiliac joints. The pain may radiate to the hips, thighs and calves especially when the nerves crossing in front of the sacroiliac joint are irritated. Initially, the pain comes on after prolonged sitting. When it gets worse, other activities like walking, climbing and running can trigger the pain.

SIJ dysfunction can be treated with medications and physical therapy. Strengthening the surrounding muscles and the core muscles helps to stabilise the sacroiliac joint. More severe form of SIJ dysfunction may require more invasive procedures like steroid injections or radiofrequency ablation. Radiofrequency ablation is done by passing heat in the form of electric current to desensitise the nerves supplying the sacroiliac joint. It can provide an excellent pain-relief. Operation to fuse the sacroiliac joint is rarely required. It is reserved for severe debilitating problems in the sacroiliac joint that do not respond well to less invasive forms of treatment.

Early Surgery in Spinal Cord Compression from Spine Tumor Gives in Better Outcome

May 5, 2018 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Actor Dan Haggerty passed away from his long battle with spine cancer in Jan 2016.

Spine cancer rarely begins in the spine itself but instead is spread to the spine from other part of the body. Spread of cancer cells to the spine is common. The spine is the third most common site for cancer cells to spread after the lung and the liver. When the spine cancer compresses the spinal cord (major nerve in the spine), the neurological function can deteriorate very rapidly resulting in paralysis.

Spine cancer more commonly occurs in people older than 40 years of age. Pain in the back and neck are the most common signs of spine cancer. Not to alarm you, but if you are above 40 and complain of back pain or neck pain that does not seem to go away, spine cancer is something you should consider getting checked for.

In spine cancer, paralysis does not occur suddenly but it can develop rapidly over few days or weeks. There are other signs and symptoms preceeding paralysis that you should look out for including:

Numbness, tingling in the arms and legs
Loss of hand coordination
Problems balancing and walking
Issues with bowel and bladder control.
Poor appetite and weight loss
Pain that is worse at night or when resting.

If you have any of these symptoms, you need see a doctor to get it checked.

When spine cancer and spinal cord compression are detected, operation to remove the spine cancer and to free up the spinal cord should be done as early as possible within 48 hours to give better outcomes according to an article published by Quraishi in European Spine Journal.

Do not wait until the neurological function is badly compromised before getting treatment. Some cancer progresses very rapidly, some slowly. Early diagnosis and treatment including surgery give much better chance of survival, faster recovery and better outcomes. When the signs and symptoms above are ignored, the cancer may be found in much worse state. Once paralysis occurs, the chance of recovery with surgery drops very significantly.

Could Long Run Lead to Osteoarthritis?

November 30, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Could Long Run Lead to Osteoarthritis?

Many people believe that running is bad for the knee and hip joints. In contrast to what many people believe, running is not only good for our hearts and lungs, it is great for our muscles, bones, and brains as well. In fact, people who run regularly are less likely to develop knee osteoarthritis compared to people with sedentary lifestyle.

Here are some of the benefits of running.

People who run regularly have more ideal body weight. Over weight puts a lot of pressure to the joint and muscles thus they wear out faster.
People who run regularly have stronger muscles. Quadriceps muscles are the stabiliser of the knee joint. The knee joint is more stable and has less wear and tear when the quadriceps muscles are strong.
Exercise helps to release the body anti-inflammatory substances. Osteoarthritis is caused by inflammation in the joint. Thus, exercise can slow down osteoarthritis by reducing the inflammation in the joint.
Exercises helps to produce greater supply of joint fluid (synovial fluid). It acts like a lubricant to the joint reducing the rate of osteoarthritis.

It does not mean that people who run regularly don’t get osteoarthritis. However, they are at a lower risk of getting one.

What can you do to reduce that chance of osteoarthritis if you like running?

Have adequate warm up before exercise so that you don’t strain your muscles
Have proper shoe wear appropriate for running
Run in even surface to reduce the risk of injury

Tumor Tulang Belakang – Salah Satu Penyebab Sakit Pinggang

November 1, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Pernahkan anda mengalami sakit pinggang?

Kebanyakan kita menyepelekan sakit pinggang yang sebagian besar akan sembuh sendiri jika beristirahat. Padahal, bisa jadi itu bukan sakit pinggang biasa. Untuk sakit pinggang yang berhubungan dengan masalah otot dan degenerative memang tidak serius. Tapi, sakit pinggang ini bisa menjadi masalah serius jika disebabkan oleh tumor.

Berikut ini adalah contoh kasus tumor tulang belakang.

Ibu Maria (bukan nama sebenarnya), 42 tahun, mengeluh sakit pinggang selama 3 bulan. Berat badan turun 5 kg. Dua hari sebelum ke dokter, secara tiba-tiba beliau tidak bisa jalan karena kaki merasa sangat lemah. Hasil pemeriksaan lengkap menunjukkan ibu Maria menderita tumor tulang belakang yang menjepit saraf. Tumor ini menyebar dari usus besar (tumor primari). Saraf yang terjepit menyebabkan kelemahan di otot kaki sampai pasien tidak kuat berjalan. Beliau menjalani operasi untuk mengambil tumor, membebaskan saraf dan menstabilkan tulang belakang. Setelah operasi ibu Maria bisa berjalan kembali dengan normal. Pasien menjalani chemotherapy dan radiotherapy untuk membasmi tumor lebih lanjut.

Tumor di tulang belakang adalah penyebab sakit pinggang yang berbahaya yang memerlukan penanganan segera. Tumor ini dapat membesar secara cepat dan tiba-tiba. Jika menjepit saraf, pasien bisa mengalami kelumpuhan secara tiba-tiba. Sering kali tumor di tulang belakang terjadi karena penyebaran sel tumor dari tempat lain seperti di usus, prostat, payudara dan lain-lain. Banyak sekali pasien yang mengeluh sakit pinggang tanpa keluhan lain seperti kasus Ibu Maria. Dengan pemeriksaan lengkap, tumor di tulang belakang dan asal tumor (tumor primari) bisa ditemukan dan ditangani secara keseluruhan. Jika pasien mengabaikan keluhan sakit pinggang, tumor ini tidak akan terdeteksi atau mungkin akan terdeteksi dalam kondisi yang lebih parah.

Jenis sakit pinggang seperti apa yang tidak boleh diabaikan?

Sebagian besar sakit pinggang tidak berbahaya. Jika sakit pinggang disertai berat badan menurun secara drastis, sakit pinggang lebih parah saat beristirahat, atau sakit pinggang yang terus menerus dan tidak pulih lebih dari satu bulan, pasien perlu segera periksa ke dokter untuk menegakkan diagnosa apakah hal ini berhubungan dengan tumor.

Mengapa tumor tulang belakang mengakibatkan sakit pinggang?

Tumor tulang belakang dapat menyebabkan sakit pinggang karena beberapa hal.

Tumor membuat tulang belakang menjadi tidak stabil.
Tumor membuat tulang belakang rapuh dan gampang patah. Sakit pinggang meningkat secara tiba-tiba jika ada patah tulang di punggung.
Tumor bisa menjepit saraf. Hal ini menyebabkan sakit pinggang terkadang menjalar ke kaki atau ke perut dan dada.

Apakah pentingnya untuk mendeteksi tumor tulang belakang secara dini?

Dengan berjalan waktu tumor bisa makin membesar, jika masih berukuran kecil tentu saja lebih gampang dioperasi dari pada sudah berukuran besar. Lebih baik lagi dioperasi sebelum tumor menjepit saraf dan mengakibatkan kelumpuhan.

Jadi jangan menyepelekan sakit pinggang yang tidak kunjung membaik apalagi jika berat badan menurun dan sakit pinggang memburuk saat istirahat. Segera periksalah ke dokter untuk mencari penyebabnya.

Dr Tony Setiobudi adalah spesialis bedah tulang dan super-spesialis bedah tulang belakang di Mount Elizabeth Hospital (Orchard), Singapore. Dr Tony menangani masalah tulang, sendi, saraf, otot dan ligamen pada orang dewasa dan anak. Dr Tony mempunyai keahlian khusus dalam penanganan saraf terjepit (HNP & spinal stenosis) & masalah tulang belakang seperti nyeri punggung & leher, scoliosis, postur bungkuk (kyphosis), tumor & infeksi tulang belakang, cedera saraf besar (spinal cord) & patah tulang osteoporosis.

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

August 18, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Postur bungkuk adalah masalah medis dan masalah estetika. Orang dengan postur bungkuk sering jatuh karena pandangan ke depan terganggu.

Postur bungkuk bisa disebabkan oleh bermacam-macam masalah medis:

Ankylosing spondylitis
Scheuermann’s disease
Proses penuaan (ageing)
Patah tulang belakang
TBC tulang belakang.

Postur bungkuk yang disebabakan oleh ankylosing spondylitis, Scheuermann’s disease dan TBC tulang belakang sering kali parah. Karena terlalu parah, sering kali pasien tidak dapat beraktifitas dengan baik. Operasi untuk menegakkan postur bungkuk ini perlu dilakukan. Dengan teknologi modern, operasi tulang belakang untuk menegakkan postur bungkuk menjadi jauh lebih aman.

Postur bungkuk ini memerlukan pemeriksaan yang menyeluruh. Ada beberapa kriteria untuk operasi terutama untuk postur bungkuk yang parah. Operasi dilakukan dengan bius total. Tulang belakang ditegakkan dengan menggunakan rods dan screws. Selain pandangan ke depan lebih normal, setelah postur lebih tegak pasien juga akan lebih tinggi. Secara estetika, pasien juga terlihat lebih tegap dan percaya diri.

Operasi menegakkan postur bungkuk ini lebih baik dilakukan secara dini semasa pasien masih muda dan sehat. Terkadang untuk pasien manula, operasi ini tidak mungkin untuk dilakukan terutama jika pasien menderita banyak penyakit kronis lain seperti diabetes, tekanan darah tinggi, sakit jantung dan lain-lain yang membuat resiko operasi lebih tinggi.

Pasien perlu tinggal di rumah sakit selama 5-7 hari. Setelah operasi pasien dirawat di ICU atau high dependency unit selama 1 malam. 2 hari setelah operasi pasien melakukan fisioterapi untuk berjalan. Setelah operasi, rasa nyeri dihilangkan dengan obat analgesik sehingga pasien tetap merasa nyaman.

Anak Saya Pendek | Apa Yang Bisa Dilakukan?

July 22, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Orang tua kuatir kalau anaknya tergolong pendek di kelas. Secara medis definisi tubuh pendek adalah ketinggian di bawah 3 percentile dibanding dengan anak dengan umur dan jenis kelamin yang sama. Secara awam artinya jika ada 100 anak dengan umur dan jenis kelamin yang sama, 3 orang terpendek, secara medis tergolong mempunyai tubuh pendek (short stature). Tetapi bukan berarti anak itu mempunyai masalah medis. Asal anak itu bertumbuh secara parallel, hal ini secara medis dianggap normal.

Apa yang mempengaruhi tinggi badan anak?

Genetik – Ketinggian anak juga tergantung ketinggian orang tuanya. Tinggi tubuh kita dipengaruhi genetik.
Late Bloomer – Kadang anak mengalami pertumbuhan terlambat. Anak ini terlihat kecil dibanding dengan teman-teman sekelasnya. Tapi saat dewasa anak dengan pertumbuhan terlambat sering kali lebih tinggi dibanding dengan mereka yang mengalami pertumbuhan lebih cepat. Ini terjadi karena anak ini masih bertumbuh tinggi di saat anak lain sudah berhenti bertumbuh tinggi.
Medical Problems – anak susah makan atau makan tidak bergizi, masalah pencernaan, masalah hormon, syndrome genetik, penyakit kronis.

Apa yang bisa dilakukan supaya pertumbuhan maximal?

Makan yang bergizi, olahraga yang teratur dan tidur yang cukup dapat membantu pertumbuhan secara maximal
Jika ada masalah medis, hal ini harus ditangani dengan baik supaya dampak terhadap pertumbuhan badan minimal.

Vertebroplasty | Injection of Cement in Osteoporotic Spine Fracture

April 1, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Spine Fracture in elderly occurs because of osteoporosis. Normal activities or minor fall can cause spine fracture if the bone is very soft. The fracture can be very painful that sitting and standing can be very uncomfortable. The back pain exists because of the injury and spinal instability in the fractured bone.

Vertebroplasty – injection of cement in the fractured bone – can provide significant pain relief almost immediately. This can provide stability of the fractured bone. Therefore, the back pain can reduce significantly. This procedure can be done as day surgery procedure under local anesthesia or general anesthesia.

The patient is lying prone on the operating table. Under local anesthesia the needle is directed towards the fractured bone with Xray as a guide. Once the tip of the needle reaches the desired position, the cement is injected slowly. The flow of the cement can be seen from the Xray.

If you have osteoporosis or osteoporosis fracture or you to check if you have osteoporosis, do not hesitate to contact us.

HP/Whatsapp: +65 9145 5793
Email: orthopaedic@spring-hope.com

Paralysis | Can It Recover with Surgery?

March 31, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Paralysis is a very devastating medical problem. The nerves supplying the arms and legs stop working resulting inability to move. People who suffer from paralysis are longing to regain the ability to move. They are desperate and are willing to try anything that can improve the chance of moving or walking again.

The brain gives instruction to move. The instruction is delivered to the muscles through the spinal cord and the nerves. Any interruption in this pathway causes difficulty or inability to move.

There are medical problems that can cause paralysis:

Spinal cord injury from spine fracture. The paralysis occurs immediately. But not all spine fractures cause spinal cord injury
Spinal cord compression from tumor or infection. Rapid expanding spine tumor or infection can cause spinal cord to stop working.
Spinal cord compression from degeneration. Spinal cord compression from spine degeneration alone rarely cause paralysis. But patients with spinal cord compression are prone to fall. Injury to the spinal cord can occur after a fall can can cause paralysis.
Spinal cord compression from spontaneous bleeding in the spinal canal. People who are on blood thinning are prone to have spontaneous bleeding.
Stroke

When paralysis has occurred, can it be treated with surgery?

When paralysis is caused by physical compression of the spinal cord, emergency surgery is required. This is to free up the spinal cord from compression and to stabilise the spine when there is fracture. The prognosis depends on how bad the spinal cord compression or injury is and how soon the surgery is done. Surgery needs to be done as soon as possible. There is a chance of getting better with surgery but it is not predictable in this case.

Is there any sign before paralysis occurs?

The sign of spinal cord compression are difficulty walking with unsteady gait, weakness and numbness in the hands or legs. Do not ignore this signs and symptoms. You need to see your doctor.

Does spinal cord compression need surgery?

Yes. spinal cord compression can only be treated with surgery. There is no other way. Surgery to free up the spinal cord before the paralysis has a much better outcome than if the surgery is done after paralysis has occurred.

If you have any inquiry about this problem, please do not hesitate to contact us.

Osteoporotic Spine Fracture

February 21, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

When the bone is soft or osteoporotic, it can fracture with trivial injury or even without injury. Spine bone is one of the most commonly affected bones in osteoporotic fracture. It can be debilitating. But it doesn’t need to affect you. You can prevent osteoporosis by having regular screening and early treatment.

Mild fracture can heal by itself. The pain may not be too bad.

In severe fracture, the back pain can be very excruciating to the extent that the patient is unable to sit, stand and walk for a period of time. If the pain prevents the patient from getting out of bed, surgical treatment is required. The surgery depends on the stability of the spinal column. If the spine is stable, the patient needs cement injection (vertebroplasty) to strengthen the bone. If the spine is not stable, bigger surgery is required with the use of spinal implants. Surgical treatment for severe fracture has a high success rate. Immediate stability of the spinal column after surgery will result in significant reduction of pain.

Osteoporotic treatment to strengthen the bone is important regardless whether surgery is required. This is to reduce the risk of having another osteoporotic fracture.

5 Facts Parents Should Know About Scoliosis

Problem in Your Buttock Can Cause Low Back Pain

Early Surgery in Spinal Cord Compression from Spine Tumor Gives in Better Outcome

Could Long Run Lead to Osteoarthritis?

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Tumor Tulang Belakang – Salah Satu Penyebab Sakit Pinggang

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Operasi Postur Bungkuk Dapat Menambah Tinggi Badan

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Anak Saya Pendek | Apa Yang Bisa Dilakukan?

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Vertebroplasty | Injection of Cement in Osteoporotic Spine Fracture

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Paralysis | Can It Recover with Surgery?

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Osteoporotic Spine Fracture

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Spring Hope Orthopaedic Spine Surgery

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