Browsing by Author "Lakhey, Rajesh Bahadur"
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Publication Iliac Crest Bone Graft Harvesting: Modified Technique for Reduction of Complications(Nepal Medical Association, 2022) Pokharel, Rohit Kumar; Paudel, Sushil; Lakhey, Rajesh BahadurAbstract: Bone graft harvesting is one of the common procedures in orthopaedics surgery, and iliac crest is the gold standard donor site for autologous bone graft. There are a number of complications related with harvesting iliac crest bone graft, “donor site pain” is the commonest one. We modified the conventional surgical technique for autogenous iliac crest bone graft on patients who underwent anterior cervical decompression/corpectomy and fusion surgeries. Among 23 patients, 18 didn’t complain more pain at the donor site compared to the neck pain on the first postoperative day and the wound on the iliac crest did not affect their mobilisation. Mean Visual Analog Score was 2.62±1.80, 1.83±1.41, and 1.10±1.20 at the time of suture removal (14 days), at six weeks and three months respectively. At one year of follow-up, no patient complained of donor site pain. Our surgical modification has encouraging results and thus can be advocated for bone graft.Publication Nerve Root Sedimentation Sign among Lumbar Canal Stenosis Patients Visiting the Department of Orthopaedics in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Pant, Yugesh Raj; Paudel, Sushil; Lakhey, Rajesh Bahadur; Pokharel, Rohit KumarAbstract Introduction: Lumbar canal stenosis is a common cause of back pain and neurogenic claudication in the elderly population. Nerve root sedimentation sign-on Magnetic resonance imaging is a novel sign proposed for the diagnosis of lumbar canal stenosis. There is limited research so far. So, the aim of this study was to find out the prevalence of nerve root sedimentation signs in lumbar canal stenosis among patients visiting the Department of Orthopaedics in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 January 2020 to 31 July 2021 in the tertiary care centre, after receiving ethical approval from the Institutional ethical review board (Reference number: 299/(6-11)076/077). The anteroposterior diameter of the dural sac at the most stenotic level and nerve root sedimentation sign in magnetic resonance images were measured in patients with lumbar canal stenosis. Point estimate and 95% Confidence Interval were calculated. Results: Among 40 patients enrolled, 34 (85%) (84.01-85.99, 95% Confidence Interval) patients had positive nerve root sedimentation sign. Out of 34 (85%) cases with positive sedimentation signs, 32 (94.12%) had severe lumbar stenosis and the remaining 2 (5.88%) had moderate lumbar stenosis. Conclusions: The prevalence of nerve root sedimentation signs is similar to the similar studies done in similar settings. Nerve root sedimentation signs on magnetic resonance imaging can be used as an objective sign for the diagnosis of severe lumbar canal stenosis.Publication Relationship between Facet Joint Tropism with Lumbar Disc Herniation at A Particular Motion Segment(Nepal Health Research Council, 2023) Shrestha, Sandesh; Lakhey, Rajesh Bahadur; Paudel, Sharma; Paudel, SushilAbstract Background: Lumbar disc herniation is one of the important and common causes of low back pain. There are various modifiable and non-modifiable risk factors for the development of lumbar disc herniation. Any change in the orientation or asymmetry of the facet joint i.e. facet tropism may lead to abnormal shearing stress on the intervertebral disc and may lead to development of disc herniation. Methods: This is a cross-sectional observational study of 46 patients aged 18-40 years with clinical features of Prolapsed Intervertebral Disc and Magnetic Resonance Imaging evidence of single level prolapsed disc who presented to Tribhuvan University Teaching Hospital from December 2019 to June 2021. MRI measurement of facet tropism of normal level (L4-L5 or L5-S1) adjacent to herniated level was used for comparison. The p - value ? 0.05 was considered statistically significant. Overall association of tropism with lumbar disc herniation in affected and normal level combined and at each individual level was studied using McNemar Test. Results: We found a highly significant association of facet tropism with lumbar disc herniation (p-value <0.001). Considering the individual levels, at L4-L5 level, the association between facet tropism and lumbar disc herniation was highly significant (p-value <0.001). However, at L5-S1 level the association was not significant (p-value <0.388). Conclusions: The results of our study show strong association between FT and lumbar disc herniation at a particular motion segment. Keywords: Facet tropism; inter-vertebral disc prolapse; lumbar disc herniation; magnetic resonance imagingPublication Relationship between Facet Joint Tropism with Lumbar Disc Herniation at A Particular Motion Segment(Nepal Health Research Council, 2023) Shrestha, Sandesh; Lakhey, Rajesh Bahadur; Paudel, Sharma; Paudel, SushilAbstract Background: Lumbar disc herniation is one of the important and common causes of low back pain. There are various modifiable and non-modifiable risk factors for the development of lumbar disc herniation. Any change in the orientation or asymmetry of the facet joint i.e. facet tropism may lead to abnormal shearing stress on the intervertebral disc and may lead to development of disc herniation. Methods: This is a cross-sectional observational study of 46 patients aged 18-40 years with clinical features of Prolapsed Intervertebral Disc and Magnetic Resonance Imaging evidence of single level prolapsed disc who presented to Tribhuvan University Teaching Hospital from December 2019 to June 2021. MRI measurement of facet tropism of normal level (L4-L5 or L5-S1) adjacent to herniated level was used for comparison. The p - value ? 0.05 was considered statistically significant. Overall association of tropism with lumbar disc herniation in affected and normal level combined and at each individual level was studied using McNemar Test. Results: We found a highly significant association of facet tropism with lumbar disc herniation (p-value <0.001). Considering the individual levels, at L4-L5 level, the association between facet tropism and lumbar disc herniation was highly significant (p-value <0.001). However, at L5-S1 level the association was not significant (p-value <0.388). Conclusions: The results of our study show strong association between FT and lumbar disc herniation at a particular motion segment. Keywords: Facet tropism; inter-vertebral disc prolapse; lumbar disc herniation; magnetic resonance imagingPublication Successful Outcome of Transfixation Technique with Linen in Dorsal Wrist Ganglion: A Descriptive Cross-sectional Study(Nepal Medical Association, 2021) Thapa, Pralhad; Lakhey, Rajesh BahadurAbstract: Introduction: Ganglion is a commonly encountered soft tissue tumor. Most commonly patients seek treatment for cosmetic issues. There are a variety of treatment options available but very few are effective and cosmetically acceptable. Common treatment techniques have either high recurrence rates or have complications. Treatment by transfixation with linen suture under local anaesthesia on an outpatient basis is an upcoming treatment. The objective of the study is to find out the prevalence of successful outcome of transfixation techniques in treatment of dorsal wrist ganglion. Methods: This study is a descriptive cross-sectional study undertaken at a tertiary care center from November 2018 to May 2020. Ethical approval was taken from the same institution. Convenient sampling method was used. Patients presenting with dorsal wrist ganglion and consenting for the transfixation underwent the procedure. All the patients were operated under local anesthesia. Statistical analysis was done using Statistical Package for Social Sciences version 24.0. Point estimate was done at 95% Confidence Interval and frequency and percentage were calculated. Results: Out of 30 cases, 29 (96.66%) have got successful outcomes with transfixation techniques. Among 30 patients, recurrences were seen in 2 (6.66%) cases. Patient satisfaction was high in 27 (90 %) cases. No complication was encountered. Conclusions: Transfixation technique had good results in terms of low recurrence rate, percentage resolution in size and high patient satisfaction.