Browsing by Author "Paudel, Sushil"
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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 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 imaging