Browsing by Author "Jha, Rajiv"
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Publication Comparison of Surgical Outcomes Following Percutaneous Pedicle Screw Fixation and Traditional Open Pedicle Screw Fixation for Thoracolumbar Fractures Without Neurological Deficit(Nepal Health Research Council, 2024) Paudel, Kumar; Lamichhane, Somraj; Jha, RajivBackground: Traumatic thoracolumbar fractures are frequently encountered in blunt trauma patients. The Open pedicle screw fixation has been proven to be effective in stabilizing fractures, deformity correction, early mobilization and improving long term quality of life of patients with thoracolumbar fracture. Percutaneous pedicle screw fixation is a minimally invasive approach that minimizes the tissue injury, enhances early recovery and facilitates rehabilitation program. Objectives: To compare the surgical outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Single center, Prospective, Comparative study Methods: A total of 34 patients with thoracolumbar fractures with intact neurology were treated with either percutaneous or open pedicle screw fixation between February 1st 2023 to March 1st 2024 at the National trauma center , Kathmandu. There were 17 patients in each group. The perioperative clinical and radiological parameters were collected using a preformed pro forma. Postoperatively follow-up was conducted at post op day 1, during discharge and 3 months. The clinical and radiological outcomes of percutaneous and open pedicle screw fixation were analyzed and compared. Results: This study included 24(70.6%) males and 10(29.4%) females. The mean age was 40.73 ±15.44 years. There was a statistically significant difference between percutaneous and open pedicle screw with regard to intraoperative blood loss, fluoroscopy time, operative duration, deambulation day and overall hospital stay (p<0.05). Overall, there was a statistically significant improvement in overall pain perception at discharge and three month follow up in both groups. The kyphosis correction in percutaneous group was similar to open pedicle screw fixation technique (mean cobbs angle correction of 4.7 degree). Conclusions: The percutaneous approach has several advantages over the open pedicle screw fixation with regard to less intraoperative blood loss, less postoperative pain, early deambulation, no was a statistically complications and shorter hospital stay Keywords: Open pedicle screw; percutaneous pedicle screw fixation; thoracolumbar fracture.Publication Factors Influencing Intraoperative Rupture of Intracranial Aneurysms(Institute of Medicine, Tribhuvan University, 2024) Khadka, Namrata; Rajbhandari, Binod; Aryal, Sameer; Bhattarai, Sushil Mohan; Shrestha, Rajendra; Jha, RajivAbstract: Introduction Intraoperative rupture (IOR) is the most anticipated yet dreaded complication during intracranial aneurysmal surgery, leading to severe adverse outcomes. This study aims to analyze various risk factors contributing to IOR. Methods It was an analytical study of 46 cases of intracranial aneurysms treated at Department of Neurosurgery, Bir Hospital including both ruptured (n=43) and unruptured (n=3) aneurysms. Incidence of IOR, demographic data, preoperative grading scales, aneurysm morphology, phases and severity of IOR along with postoperative complications and outcomes were assessed. Results IOR occurred in 28.26% (13/46) cases of intracranial aneurysms. Most common aneurysm was anterior communicating artery aneurysm (43.5%, 20/46) with majority of IOR (65.1%).Younger patients and males had higher rates of IOR, and early surgical intervention (within 72 hours) was associated with increased incidence (69.2%,9/13). Although preoperative factors showed no direct correlation with IOR, aneurysm size and morphology-dome width and height ratio (W/H) and irregular shapes of aneurysm emerged as critical risk factors (p<0.05). Temporary clipping during surgery appeared to reduce IOR, mostly mild (13.04%, 6/13) and occurred in second phase (17.39%; 8/13, during microdissection and neck preparation). However, IOR did not have adverse effects on postoperative complications and Glasgow Outcome Scale Extended (GOSE) at discharge. Conclusion Incidence of IOR was 28.65%. Younger age, males, higher Fisher score, early timing of surgery of aneurysms and larger size increased the risk, while use of temporary clip reduced the risk. Dome H/W ratio and irregular shapes of aneurysm were important factors predicting IOR in this study.Publication Long-level Intramedullary Spinal Cord Tumor: A Case Series(Nepal Medical Association, 2025) Khadka, Namrata; Suryabanshi, Anil; Shrestha, Apurva; Paudel, Kumar; Aryal, Sameer; Jha, Binit; Bhattarai, Sushil Mohan; Rajbhandari, Binod; Shrestha, Rajendra; Jha, RajivAbstract Spinal cord tumors, though uncommon, pose significant challenges due to their potential for neurological disability and mortality. Intramedullary spinal cord tumors, particularly Long-level intramedullary spinal cord tumors, present challenging clinical scenarios. Contrast-enhanced Magnetic resonance imaging remains pivotal for radiological evaluation and surgical planning. Notably, aggressive resection is advocated to enhance prognosis, with meticulous attention to preserving neurological function. Advancements in spinal surgery techniques, coupled with intraoperative monitoring, offer promising avenues for improved patient outcomes. We presented three cases of long-level intramedullary tumors, emphasizing the significance of tailored management and presented details, including clinical presentations, radiological findings, and histopathological results.