Browsing by Author "Sigdel, A"
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Publication Modified Altissimi and Mancini technique for carpal tunnel decompression(Institute of Medicine, 2012) Sigdel, A; Uprety, S; K.C., GovindAbstract Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia. Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia. Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury. Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique.Publication Per-operative Instrument Failure in Lumbar Spine Surgery(Institute of Medicine, 2013) Pokharel, R K; Lakhey, R B; Kafle, D; Pokharel, B; Dhakal, R K; Sigdel, A; Lalit, T; Shah, L L; Kafle, DAbstract Breakage of hardware is not an uncommon complication in spine surgery practice. Pedicle screw breakage is the commonest instrument failure encountered in spine surgery, and different relatively simple, techniques have been recommended to retrieve the threaded part of it. Per-operative breakage of an instrument like pedicle seeker and jaw of disc forceps is unpredictable and removal of an unthreaded smooth implant is difficult. We experienced breakage of the pedicle seeker while putting a pedicle screw in a case of spondylolisthesis and breakage of the mobile jaw of a disc forceps in another case of prolapsed intervertebral disc. Here we present an innovative technique of removal of the broken instrument through the pedicle. Regular maintenance and replacement of al old instrument is recommended. Keywords: per-operative instrument breakage, spine surgeryPublication Surgical Management of Recurrent Herniated Lumbar Disc at TU Teaching Hospital(Institute of Medicine, 2003) Shilpakar, SK; Sigdel, A; Sharma, MRAbstract Over the duration of eight and half years, we had performed over 158 cases of hernitated lumbar disc surgeries at Tribhuvan University Teaching Hospital. Among them, there were altogether 6 cases with recurrent herniated disc at the same or the adjacent level. The demographic profile, clinical pictures, surgical management and the outcome are presented. Our limited experience and technical recommendation for the surgical mangement of such recurrent lumbar disc pathologies are also discussed in detail. Keywords: Recurrent herniated lumbar disc, Surgical outcome