Browsing by Author "Kafle, Dinesh"
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Publication Clinical Outcome of Posterior Instrumented Stabilization and Transpedicular Decompression in Patients Presenting with Thoracic or Lumbar Spinal Tuberculosis in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Bhandari, Dinesh; Pokharel, Sabin; Pokharel, Praja; Paudel, Sushil; Kafle, Dinesh; Pokharel, Rohit KumarAbstract Introduction: Posterior instrumented stabilization is a commonly done surgery in spinal tuberculosis. This study aims to evaluate the clinical, radiological, and neurological outcomes of posterior instrumented stabilization and transpedicular decompression in thoracic and lumbar spinal tuberculosis. Methods: A descriptive cross-sectional study was conducted for one and a half years with at least six months of follow-up in a tertiary care center. The study was approved by the Institutional Review Committee (Reference number: 119 (6-11-5) 2/075-076). Total sampling was done and the study included patients over 18 years of age with spinal tuberculosis of the thoracic or lumbar regions. These patients underwent posterior instrumented stabilization and transpedicular decompression at the tertiary care center. The age, site of involvement, Visual Analog Scale score for back pain, neurological status as per Frankel Neurology grading, and local kyphotic angle in X-ray were recorded. The median, interquartile range and percentage were calculated. The data was entered in Microsoft Excel 2016 and analysis was done using Epi Info software version 7.2. Results: Thoracic level was most commonly involved in 14 (46.68%) cases. The median back pain as assessed by the Visual Analogue Scale score improved from 8 to 2 at the 6-month follow-up. There was improvement in the neurological grading of all cases and there was no loss of correction in the local kyphotic angle till the final follow-up. The median age of cases was 48 years (interquartile range: 28-62.50). Conclusions: Posterior instrumented stabilization and transpedicular decompression in adult patients with thoracic or lumbar spinal tuberculosis achieves improvements in clinical, radiological, and neurological outcomes.Publication Multilevel Spinal Injury: Incidence, Distribution and Neurological Patterns(Institute of Medicine, 2020) Khadka, Yagya; Lakhey, Rajesh B; Kafle, DineshABSTRACT Introduction: Fractures and dislocation of spine are serious injuries that most commonly occur in young people. Spinal injury at more than one level is not uncommon. Awareness of multilevel injury of the spine and associated neurological patterns is important for the proper initial management of the patient. Methods: This was a prospective observational study carried out in Department of Orthopedics, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal from February 2012 to September 2013. Sixty cases of age group between 18 to 63 years of traumatic spinal injury were enrolled. Patients were examined clinically and radiographically. Results: Out of 60 patients, multilevel spinal injury occurred in 26 (43.3%) patients; 10 (16.67%) had contiguous spinal injury and 16 (26.67%) had non-contiguous spinal injury. There were 5 type A pattern spinal injury. Contiguous spinal injury most commonly occurred at level L1/L2 (n=4, 40%) and most had Frankel grade E neurology (n=6, 60%) followed by Frankel grade D (n=2, 20%). Non-contiguous lesions most commonly occurred at thoracic spine and had Frankel grade E neurology in most cases (n=10, 16.67%) followed by grade B and C (n= 2, 2.33% each). Conclusion: Multiple spinal injury was a common pattern of injury, which occurred in 26 (43.3%) patients out of 60 patients enrolled in our study. Multilevel spinal injury is common. We should be aware about its occurrence. We should evaluate for multilevel spinal injuries, so as not to miss them, especialy non-contiguous injuries, in the patients presenting with spinal injury. Keywords: Contiguous lesion, Frankel grade, multilevel spinal injury, non-contiguous lesion