Skiatika: Perbedaan antara revisi

{{Infobox medical condition|name=Skiatika|image=Sciatic nerve2.jpg|caption=Gambaran tampak anterior menunjukkan nervus skiatika berjalan menyusuri kaki kanan|specialty=[[Bedah ortopedi|Ortopedi]], [[neurologi]]|synonym=Neuritis skiatika, neuralgia skiatik, radikulopati lumbal|pronounce=|symptoms=[[Nyeri]] menjalar ke tungkai dari punggung, kelemahan atau mati rasa pada kaki yang dipersarafi<ref name=NIH2015>{{cite web|title=Sciatica|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|accessdate=2 July 2015|url-status=live|archiveurl=https://web.archive.org/web/20180307160812/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|archivedate=7 March 2018}}</ref>|onset=usia 40–50 tahun<ref name=NIH2014b>{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|archiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archivedate=8 September 2017}}</ref><ref name=NEJM2015>{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref>|duration=90% kurang dari 6 minggu<ref name=NIH2014b>{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|archiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archivedate=8 September 2017}}</ref>|causes=[[Hernia Nukleus Pulposus]], [[spondilolistesis]], [[stenosis spinal]], [[sindrom piriformis]], [[tumor pelvis]]<ref name=NEJM2015>{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref><ref name=Valat2010>{{cite journal|last=Valat|first=JP|author2=Genevay, S |author3=Marty, M |author4=Rozenberg, S |author5= Koes, B |title=Sciatica.|journal=Best Practice & Research. Clinical Rheumatology|date=April 2010|volume=24|issue=2|pages=241–52|pmid=20227645|doi=10.1016/j.berh.2009.11.005}}</ref>|risks=|diagnosis=[[Tes angkat kaki lurus]]<ref name=NEJM2015>{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref>|differential=[[Herpes zoster]], penyakit panggul<ref name=NEJM2015>{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref>|prevention=|treatment=[[analgesik|Pereda nyeri]], [[bedah]]<ref name=NIH2014b>{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|archiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archivedate=8 September 2017}}</ref>|medication=|prognosis=|frequency=2–40% dari populasi<ref name=Valat2010>{{cite journal|last=Valat|first=JP|author2=Genevay, S |author3=Marty, M |author4=Rozenberg, S |author5= Koes, B |title=Sciatica.|journal=Best Practice & Research. Clinical Rheumatology|date=April 2010|volume=24|issue=2|pages=241–52|pmid=20227645|doi=10.1016/j.berh.2009.11.005}}</ref>|deaths=}}'''Skiatika''' adalah [[nyeri]] yang terasa menjalar dari [[Punggung manusia|punggung bawah]] ke tungkai. <ref name="NIH2015">{{Citecite web|title=Sciatica|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|url-status=live|access-dateaccessdate=2 July 2015|archive-url-status=live|archiveurl=https://web.archive.org/web/20180307160812/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|archive-datearchivedate=7 March 2018}}</ref> Nyeri ini dapat pula menjalar ke beberapa bagian dari tungkai, seperti punggung, luar, atau bagian depan kaki. <ref name="NEJM2015">{{Citecite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151|last=Ropper|first=AH}}</ref> Serangan nyeri sering terjadi tiba-tiba setelah aktivitas seperti angkat berat. Awitan nyeri juga dapat terjadi secara bertahap. <ref name="FowlerScadding2003">{{Cite book|last=T.J. Fowler|last2=J.W. Scadding|date=28 November 2003|url=https://books.google.com/books?id=k56tZUQ8RfkC&pg=PA59|title=Clinical Neurology, 3Ed|publisher=CRC|isbn=978-0-340-80798-9|page=59|access-date=5 November 2017|archive-url=https://web.archive.org/web/20200328205908/https://books.google.com/books?id=k56tZUQ8RfkC&pg=PA59|archive-date=28 March 2020|url-status=live}}</ref> Biasanya penderita seringkali mengalami nyeri seperti ditembak di bagian tubuh yang terdampak.<ref name="NIH2015">{{cite web|title=Sciatica|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|accessdate=2 July 2015|url-status=live|archiveurl=https://web.archive.org/web/20180307160812/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|archivedate=7 March 2018}}</ref> Umumnya, gejala hanya ada di satu sisi dari tubuh. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> Pada beberapa kesempatan, nyeri juga dapat dialami di kedua sisi tubuh. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> [[Nyeri punggung|Nyeri punggung bagian bawah]] juga kadang-kadang muncul. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> Kelemahan atau mati rasa juga dapat terjadi di berbagai bagian tungkai dan kaki yang terkena. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref>

Sekitar 90% dari skiatika ini disebabkan oleh [[Hernia Nukleus Pulposus|herniasi nukleus pulposus]]. Herniasi ini menekan salah satu ujung saraf lumbal atau sakral. <ref name="Valat2010">{{Citecite journal|last=Valat|first=JP|author2=Genevay, S |author3=Marty, M |author4=Rozenberg, S |author5= Koes, B |title=Sciatica.|journal=Best Practice & Research. Clinical Rheumatology|date=April 2010|volume=24|issue=2|pages=241–52|pmid=20227645|doi=10.1016/j.berh.2009.11.005|last2=Genevay, S|last3=Marty, M|last4=Rozenberg, S|last5=Koes, B}}</ref> [[Spondilolistesis]], stenosis tulang belakang, sindrom piriformis, tumor panggul, dan [[kehamilan]] merupakan beberapa penyebab linu panggul lainnya. <ref name="NEJM2015">{{Cite journal|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151|last=Ropper|first=AH}}<cite class="citation journal cs1" data-ve-ignore="true" id="CITEREFRopperZafonte2015">Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica". ''The New England Journal of Medicine''. <b>372</b> (13): 1240–8. [[doi (identifier)|doi]]:[https://doi.org/10.1056%2FNEJMra1410151 10.1056/NEJMra1410151]. [[PMID (identifier)|PMID]]&nbsp;[https://pubmed.ncbi.nlm.nih.gov/25806916 25806916].</cite></ref> Tes <i>straight-leg-raising</i> sering juga dilakukan membantu menegakkan diagnosis. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> Tes ini dikatakan positif jika rasa sakit dirasakan menjalar di bawah lutut saat kaki diangkat ketika pasien berbaring telentang. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref>

Dalam kebanyakan kasus, pencitraan medis sebenarnya tidak diperlukan.<ref name="NIH2014b">{{Citecite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|last=Institute for Quality and Efficiency in Health Care|access-date=2 July 2015|archive-urlarchiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archive-datearchivedate=8 September 2017}}</ref> Akan tetapi, pencitraan sebaiknya dilakukan jika ditemukan ada masalah dalam fungsi usus atau kandung kemih, adanya kehilangan rasa atau kelemahan yang signifikan pada tungkai, gejala sudah berlangsung lama, atau ada kekhawatiran akan adanya tumor ataupun infeksi.<ref name="NIH2014b" /> Gejala penyakit yang mungkin muncul mirip dengan kasus ini adalah penyakit panggul dan infeksi [[herpes zoster]] dini (sebelum adanya ruam). <ref name="NEJM2015" />

Penatalaksanaan awal biasanya melibatkan penggunaan [[Analgesik|obat pereda rasa sakit]]. <ref name="NIH2014b">{{Cite web|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|date=October 9, 2014|url-status=live|last=Institute for Quality and Efficiency in Health Care|access-date=2 July 2015|archive-url=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archive-date=8 September 2017}}<cite class="citation web cs1" data-ve-ignore="true" id="CITEREFInstitute_for_Quality_and_Efficiency_in_Health_Care2014">Institute for Quality and Efficiency in Health Care (October 9, 2014). [https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/ "Slipped disk: Overview"]. [https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/ Archived] from the original on 8 September 2017<span class="reference-accessdate">. Retrieved <span class="nowrap">2 July</span> 2015</span>.</cite></ref> Akan tetapi manfaat obat pereda nyeri dan pelemas otot masih kurang memiliki bukti yang memadai. <ref name="Koes 1313–1317">{{Cite journal|last=Koes|first=B W|last2=van Tulder|first2=M W|last3=Peul|first3=W C|date=2007-06-23|title=Diagnosis and treatment of sciatica|journal=BMJ : British Medical Journal|volume=334|issue=7607|pages=1313–1317|doi=10.1136/bmj.39223.428495.BE|issn=0959-8138|pmc=1895638|pmid=17585160}}</ref> Umumnya pasien disarankan agar pasien tersebut melanjutkan kegiatan sehari-hari secara normal sebaik mereka mampu. <ref name="NEJM2015">{{Cite journal|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151|last=Ropper|first=AH}}<cite class="citation journal cs1" data-ve-ignore="true" id="CITEREFRopperZafonte2015">Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica". ''The New England Journal of Medicine''. <b>372</b> (13): 1240–8. [[doi (identifier)|doi]]:[https://doi.org/10.1056%2FNEJMra1410151 10.1056/NEJMra1410151]. [[PMID (identifier)|PMID]]&nbsp;[https://pubmed.ncbi.nlm.nih.gov/25806916 25806916].</cite></ref> Pada sekitar 90% orang, rasa nyeri akan berkurang dalam waktu kurang dari enam minggu. <ref name="NIH2014b">{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|archiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archivedate=8 September 2017}}</ref> Jika rasa sakitnya memburuk dan berlangsung selama lebih dari enam minggu, opsi tindakan bedah dapat menjadi pilihan. <ref name="NIH2014b">{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|archiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archivedate=8 September 2017}}</ref>

Meskipun tindakan bedah dapat mempercepat perbaikan nyeri, manfaat jangka panjangnya belum diketahui secara jelas. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> Pembedahan mungkin diperlukan jika terjadi komplikasi, seperti hilangnya fungsi normal usus atau kandung kemih. <ref name="NIH2014b">{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|accessdate=2 July 2015|date=October 9, 2014|url-status=live|archiveurl=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archivedate=8 September 2017}}</ref> Kurangnya bukti penelitian menyebabkan kebanyakan pengobatan, termasuk pemberian gabapentin, [[kortikosteroid]], pregabalin, [[akupunktur]], terapi panas atau es, dan manipulasi tulang belakang masih perlu diteliti manfaat dan efek buruknya. <ref name="NEJM2015">{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> <ref>{{Cite journal|last=Markova|first=Tsvetio|date=2007|title=Treatment of Acute Sciatica|url=http://www.aafp.org/afp/2007/0101/p99.html|journal=Am Fam Physician|volume=75|issue=1|pages=99–100|pmid=17225710|archive-url=https://web.archive.org/web/20160202170917/http://www.aafp.org/afp/2007/0101/p99.html|archive-date=2016-02-02|url-status=live}}</ref> <ref name="pmid29970367">{{Cite journal|date=July 2018|title=Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis|journal=CMAJ|volume=190|issue=26|pages=E786–E793|doi=10.1503/cmaj.171333|pmc=6028270|pmid=29970367|vauthors=Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CC}}</ref>