Browsing by Author "Amatya, Shirish Prasad"
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Publication Clinical Outcome for Lumbar Disc Herniation Treatment with Intradiscal Oxygen-ozone Therapy(Nepal Health Research Council, 2023) Yadav, Rupesh Kumar; Sherpa, Tshering; Hamal, Pawan Kumar; Pokhrel, Nabin; Thakur, Jay Prakash; Amatya, Shirish Prasad; Piya, RoshanAbstract Background: Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical treatment has been main stay of treatment when indicated but is associated with anesthetic and surgical complications. Intradiscal oxygen-ozone chemonucleolysis is minimum invasive procedure done under local anesthesia and has promissing role in shrinking the bulged disc and reducing nerve root compression and related symptoms. This retrospective study was done to see how intradiscal oxygen-ozone chemonucleolysis reduces the pain severity in patient with discogenic low back pain. Methods: Retrospective data were retrieved of those patients who underwent fluoroscopy guided intradiscal oxygen-ozone chemonucleolysis with 5-6 ml of an O2-O3 mixture (concentration of 30 microgram/ml) during the period of two years in Nepal pain care and research center. Numerical pain scale (NRS) at various follow ups were compared to preprocedural NRS. Results: Preprocedural NRS was 8± 1. NRS at three hours, one week, one month, three months and six months were 2± 0.3 (73.44 percent reduction), 2.5± 2 (68.85 percent reduction), 2.3± 2 (72.13 percent reduction), 1.8± 1.7 (77.87 percent reduction) and 1.67± 1.4 (79.51 percent reduction) respectively. Conclusions: Intradiscal oxygen-ozone chemonucleolysis can be useful modality of treatment for discogenic low back pain when failed to respond to the conservative management and in whom surgery is not indicated. Keywords: Chemonucleolysis; disc prolapse; fluoroscopy; low back pain; ozone.Publication Ultrasound Guided Trigger Point Injection and Sciatic Nerve Hydrodissection for Atypical Piriformis Syndrome: A Case Report(Nepal APF Hospital, 2026) Pun, Iswar Kumar; Amatya, Shirish Prasad; Moktan, Sushila Lama; Lamichhane, Suraj; Pun, InshaAbstract: Introduction : Chronic low back pain is a common complaint and is often attributed to lumbar disc disease. Less recognized causes, such as piriformis syndrome, can be overlooked, especially when routine tests and imaging are inconclusive. Early accurate diagnosis and targeted therapy are essential for effective pain relief. Case presentation: A 39-year-old male experienced six years of atraumatic low back pain radiating to his left leg and sole, worsening over 10 days and aggravated by prolonged sitting or standing. Examination revealed left piriformis tenderness but negative provocative tests, with minimal sensory deficit in the left L5 dermatome. Imaging showed a lumbarisation of sacral vertebra and L4–L5 disc bulge with bilateral lateral recess narrowing causing indentation of L4 exiting nerve root, which did not fully explain his symptoms. He had previously tried physiotherapy, oral steroids, neuromodulators, and analgesics without relief. Ultrasound-guided piriformis trigger point injection and sciatic nerve hydrodissection provided rapid and significant pain relief, confirming the piriformis as the primary pain source. Conclusion: This case highlights the diagnostic and therapeutic utility of ultrasound-guided, safe, and minimally invasive interventions in atypical piriformis syndrome refractory to conservative management.