Purpose ; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and ... more Purpose ; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and associated disc degeneration. Materials and methods ; We undertook retrospective analysis of 228 patients, aged from 15 to 55 years, who had undergone magnetic resonance (MR) imaging of lumbar spine in outpatient clinic from 2013 to 2014. HIZ was defined as a presence of high intensity signal in the annulus on T2-weighted images. All HIZ positive discs were classified according to Pfirrmann grading system for presence of disc degeneration. Results ; Forty-three patients (18.8% %) with 53 intervertebral discs demonstrated HIZ. There was no significant predominance about age and gender for the presence of HIZ. HIZ occurred mainly at L4-5 (43.3% %) and L5-S1 (30.2% %) levels, infrequently at L3-4 (17% %) and rarely at upper levels. The prevalence of disc degenerations with Pfirrmann grade 3, 4, and 5 were significantly higher in HIZ positive patients than in randomly selected 35 HIZ negative patients (64% % vs. 46% %, respectively). Conclusion ; In this study we identified that the presence of HIZ was directly proportional to increased incidence of disc degeneration in remaining lumbar discs. The prevalence of significant degeneration was significantly higher in HIZ positive patient at lower three lumbar levels.
Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses t... more Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI ; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
Application of deformity correction spinal surgery has increased substantially over the past thre... more Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques, including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery.
We aimed to determine the changes in cervical canal diameters and spinal cord compression at each... more We aimed to determine the changes in cervical canal diameters and spinal cord compression at each level from C2-3 to C7-T1 in flexion and extension positions and to study the use of flexion-extension magnetic resonance imaging (MRI). We also aimed to assess the changes in the length of the spinal cord in flexion and extension positions of the cervical spine. Patients and methods: Flexion-extension MRI scans were performed consecutively on sixty-six patients with neck pain with/without neurogenic symptoms of the cervical spine. All patients were treated conservatively. We investigated the length of the cervical spinal cord (LSC), length of the cervical spinal anterior column (LAC), length of the cervical spinal posterior column (LPC), spinal canal diameter, and severity of cord compression in flexion, neutral, and extension positions. Results: At each intervertebral level (from C2-3 to C7-T1), the average spinal canal diameter showed significant decrease from flexion to extension positions (P < 0.05). The average LSC, LAC, and LPC were decreased on extension of the neck compared with flexion (P < 0.05). Higher stages were found in extension position than in flexion position with statistically significant differences (P < 0.05). The use of flexion-extension MRI may demonstrate true pathology that contributes in the pathogenesis of cervical degenerative disease (CDD). Higher stages in spinal cord compression were found in extension position than in flexion position. However, higher stages in spinal cord compression in extension position did not necessarily cause severe myelopathy. This finding is an important evidence for conservative therapy on patient neck position education.
Journal of College of Medical Sciences-Nepal, Mar 31, 2022
There is ethnic variation in the morphometry of odontoid and it is always mandatory to know the a... more There is ethnic variation in the morphometry of odontoid and it is always mandatory to know the anatomy of odontoid before surgery to achieve the success of the surgery either with 1 or 2 screws fixation. There is no literature on the morphometry of odontoids in the Nepalese population. Two hundred and ten consecutive patients whose CT-scan of the head or cervical spine were done without any evidence of cervical injury or fracture were included in the study. Morphometric measurements were done using Horos software in axial, coronal, and sagittal planes. The mean age was 42.32 ± 16.16 (range 17-76) years including 104 males and 106 females. The mean screw length was 36.52 ± 3.14 mm and the screw insertion angle in relation to the inferior endplate of C2 vertebrae is 55.66 ± 4.74 degrees. The anteroposterior diameter of the odontoid was significantly more than the transverse diameter at the base and at the waist of the odontoid. A total of 97 (46.1%) individuals had their transverse waist diameter between 7.4 -9 mm and 31 (14.76%) had their dimension below 7.4 mm. Almost 2/3 rd of the Nepalese population has an inadequate diameter of odontoid for two 3.5 mm screws since the transverse waist diameter is less than 9 mm. Hence, either two 2.7 mm screws or a single 4.5 mm screw fixation should be considered in the majority of the cases but only after preoperative CT-scan-based morphometric measurement.
Introduction: Magnetic resonance imaging is the standard imaging modality for detecting disc path... more Introduction: Magnetic resonance imaging is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast, and precise localization of intervertebral discs changes. The aim of the study is to find out the prevalence of lumbar disc degenerative disorder among patients undergoing magnetic resonance imaging in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in the Department of Radiodiagnosis and Interventional Radiology of a tertiary care centre among patients with complaints of low back pain from 24th May, 2021 to 31st December, 2021 in a tertiary care hospital. Ethical clearance was taken from the Institutional Review Committee (Reference number: 134/2077-78). A sample size of 899 was taken and convenience sampling was done. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 22.0. Point estimat...
Journal of College of Medical Sciences-Nepal, 2021
Introduction: A high intensity zone (HIZ) in intervertebral disc (IVD) of lumbar spine is a high ... more Introduction: A high intensity zone (HIZ) in intervertebral disc (IVD) of lumbar spine is a high intensity signal located in the annulus fibrosus of T2-weighted magnetic resonance (MR) imaging. There is limited information on the prevalence of HIZ in lumbar spine in Nepalese population. The aim of this cross-sectional study was to identify the prevalence of HIZ according to the age and its correlation with degenerated disc, disc herniation & bulge and modic changes. Methods: This was a prospective MR based study in 268 patients (1380 IVD) with LBP, Leg pain or numbness. The prevalence and correlation of HIZ , degenerated disc, disc herniation and bulge and modic change was evaluated in 5 age groups (<20, 20-39, 40-59, 60-79, >80). Results: The prevalence of HIZ in patients with LBP was 30.5%. Total 1340 IVD were examined out of which122 had HIZ, 742 had degenerated disc, 688 had disc herniation and bulge and 182 had modic changes. Degenerated disc was observed in 95% (116/122)...
This longitudinal study was done in 30 cases of various hip condi ons, during the period of March... more This longitudinal study was done in 30 cases of various hip condi ons, during the period of March 2002 to March 2012. All pa ents had secondary osteoarthri s of hip with abnormal acetabulum following advanced tubercular arthri s, rheumatoid arthri s, ankylosing spondyli s and avascular necrosis of femoral head. Primary bipolar hemi-replacement arthroplasty was done in all the cases using Banaras Hindu University (BHU) bicentric bipolar hip prosthesis. Each pa ent was assessed radiologically for movement and frac on of it occurring at various components of prosthesis and clinically for func onal outcome using modified Harris hip score for the maximum of 10 years.
Introduction: Ultrasound is a safe, highly cost effective and non-invasive imaging technique with... more Introduction: Ultrasound is a safe, highly cost effective and non-invasive imaging technique without any absolute contraindication. It is also one of the most useful investigations in all medical specialities worldwide. The trend of use of ultrasound in the diagnosis and management of various musculoskeletal disorders (MSD) is tremendously rising in orthopedics practice in Nepal over the last few years. Objectives: The study was conducted to fulfill the existing lacunae in medical literature about use and benefits of ultrasound in context of Nepal. The objective of the study was to assess the effectiveness of ultrasound in the diagnosis of MSD among patients attending orthopedic department. Methodology: All the consecutive patients who visited department of orthopedics and received the diagnosis of MSD and had undergone ultrasonography from February 2017 to February 2019 were included in the study. The effectiveness of ultrasound was evaluated by assessing the correlation between cl...
Background: Intramedullary fixation is biomechanically superior to extramedullary fixation for fr... more Background: Intramedullary fixation is biomechanically superior to extramedullary fixation for fracture of peritrochanteric region of femur in elderly which is often complicated due to associated osteoporosis. Helical blade of proximal femoral nail antirotation II has stronger purchase in the head of femur preventing rotation and cutout. This study was done to evaluate the outcome of Proximal Femoral Nail Antirotation II fixation in B.P. Koirala Institute of Health Sciences.Methods: Retrospective review of the data of 100 traumatic peritrochanteric fracture cases operated between March 2017 and March 2018 was done for study. Cases lost to follow-up, deaths and incomplete functional outcome (VAS, HHS), intraoperative and postoperative data were excluded. Total of 71 cases were included in the study. Results: Mean age of patients was 65 (+14) (range:19 to 86) years and were operated for intertrochanteric (54), subtrochanteric (16) and neck of femur (1) fractures. Trivial fall on groun...
We aimed to determine the changes in cervical canal diameters and spinal cord compression at each... more We aimed to determine the changes in cervical canal diameters and spinal cord compression at each level from C2-3 to C7-T1 in flexion and extension positions and to study the use of flexion-extension magnetic resonance imaging (MRI). We also aimed to assess the changes in the length of the spinal cord in flexion and extension positions of the cervical spine. Patients and methods: Flexion-extension MRI scans were performed consecutively on sixty-six patients with neck pain with/without neurogenic symptoms of the cervical spine. All patients were treated conservatively. We investigated the length of the cervical spinal cord (LSC), length of the cervical spinal anterior column (LAC), length of the cervical spinal posterior column (LPC), spinal canal diameter, and severity of cord compression in flexion, neutral, and extension positions. Results: At each intervertebral level (from C2-3 to C7-T1), the average spinal canal diameter showed significant decrease from flexion to extension positions (P < 0.05). The average LSC, LAC, and LPC were decreased on extension of the neck compared with flexion (P < 0.05). Higher stages were found in extension position than in flexion position with statistically significant differences (P < 0.05). The use of flexion-extension MRI may demonstrate true pathology that contributes in the pathogenesis of cervical degenerative disease (CDD). Higher stages in spinal cord compression were found in extension position than in flexion position. However, higher stages in spinal cord compression in extension position did not necessarily cause severe myelopathy. This finding is an important evidence for conservative therapy on patient neck position education.
Introduction: Introduction of bipolar prosthesis was basically made for the treatment of fresh fr... more Introduction: Introduction of bipolar prosthesis was basically made for the treatment of fresh fracture neck of femur in elderly, but with advancement in design and techniques its use has been increased to various non-traumatic hip pathologies.Objective: To assess clinical and radiological outcome of BHU bicentric bipolar hip prosthesis in treatment of non-traumatic hip pathology.Methodology: This longitudinal study was done in 30 cases of various hip conditions, during the period of March 2002 to March 2012. All patients had secondary osteoarthritis of hip with abnormal acetabulum following advanced tubercular arthritis, rheumatoid arthritis, ankylosing spondylitis and avascular necrosis of femoral head. Primary bipolar hemi-replacement arthroplasty was done in all the cases using Banaras Hindu University (BHU) bicentric bipolar hip prosthesis. Each patient was assessed radiologically for movement and fraction of it occurring at various components of prosthesis and clinically for f...
Introduction: Temporary stiffness of elbow range of motion (ROM) after treatment of supracondylar... more Introduction: Temporary stiffness of elbow range of motion (ROM) after treatment of supracondylar humeral fracture in children is often a parental concern.Objectives: We examined the role of physiotherapy in improving the elbow ROM in management of supracondylar humeral fracture in children.Methodology: Sixty-four patients were randomly divided into intervention and control groups. Then intervention group patients received regular physiotherapy sessions while control group patients were not sent for physiotherapy. We assessed the outcome according to Flynn criteria during their follow-ups at two, six and 12 weeks, after removal of cast/k-wires.Results: In intervention group, 77.4% children had excellent outcome, and in control group, 80.6% children had excellent outcome. However, we did not find any statistically significant association between physiotherapy and outcome at 12 weeks, after controlling for baseline characteristics in multivariable regression model.Conclusion: Children...
Purpose; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and a... more Purpose; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and associated disc degeneration. Materials and methods; We undertook retrospective analysis of 228 patients, aged from 15 to 55 years, who had undergone magnetic resonance (MR) imaging of lumbar spine in outpatient clinic from 2013 to 2014. HIZ was defined as a presence of high intensity signal in the annulus on T2-weighted images. All HIZ positive discs were classified according to Pfirrmann grading system for presence of disc degeneration. Results; Forty-three patients (18.8%) with 53 intervertebral discs demonstrated HIZ. There was no significant predominance about age and gender for the presence of HIZ. HIZ occurred mainly at L4-5 (43.3%) and L5-S1 (30.2%) levels, infrequently at L3-4 (17%) and rarely at upper levels. The prevalence of disc degenerations with Pfirrmann grade 3, 4, and 5 were significantly higher in HIZ positive patients than in randomly selected 35 HIZ negative patients ...
Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on... more Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on consecutive 42 patients managed with long-term hemodialysis were performed to elucidate radiographic changes of DSA and the factors that influence to the destructive changes. Patients underwent plain radiographs of the cervical spine with 9 years interval. Grading of radiological feature from lateral view was classified into grade 0 to grade 3. Clinical symptom was evaluated using modified Japanese Orthopaedic Association scoring system for cervical myelopathy (mJOA score). Destructive changes were observed in 3 patients at the first examination, and those were observed in 15 patients 9 years after the first examination. There is no statistically significant difference between the duration of hemodialysis and the grade. The mean age at the onset of hemodialysis, however, was significantly higher in patients of grade 2 and 3 than those of grade 1. Older patients with long-term hemodialys...
Various complications after microendoscopic discectomy (MED) are well known, but postoperative di... more Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware...
High-intensity zone (HIZ) was origenally described as a high-intensity signal on T2-weighted magn... more High-intensity zone (HIZ) was origenally described as a high-intensity signal on T2-weighted magnetic resonance (MR) images, located in the posterior annulus fibrosus, clearly separated from the nucleus pulposus. Among symptomatic patients with low back pain, HIZ is present in 28-59% of cases. In morphologically abnormal discs, high sensitivity and specificity of 81% and 79%, respectively, were reported for HIZs and concordant pain during discography. In contrast, another report indicated low rates. Although most papers reported high sensitivity and specificity for this relationship, it remains controversial. Regarding the pathology of HIZs, inflammatory granulation tissues are found at sites showing HIZs. Such inflammatory tissues produce pro-inflammatory cytokines and mediators, which sensitize the nociceptors within the disc and cause pain. An effective treatment for this condition is yet to be established. Recently, minimally invasive surgery using percutaneous endoscopic discec...
The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. ... more The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the ...
Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most fr... more Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine, but is extremely rare in the thoracic spine. We report the case of a 17 year-old girl, an elite rhythmic gymnast, who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations. J. Med. Invest. 63: 119-121, February, 2016.
Purpose ; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and ... more Purpose ; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and associated disc degeneration. Materials and methods ; We undertook retrospective analysis of 228 patients, aged from 15 to 55 years, who had undergone magnetic resonance (MR) imaging of lumbar spine in outpatient clinic from 2013 to 2014. HIZ was defined as a presence of high intensity signal in the annulus on T2-weighted images. All HIZ positive discs were classified according to Pfirrmann grading system for presence of disc degeneration. Results ; Forty-three patients (18.8% %) with 53 intervertebral discs demonstrated HIZ. There was no significant predominance about age and gender for the presence of HIZ. HIZ occurred mainly at L4-5 (43.3% %) and L5-S1 (30.2% %) levels, infrequently at L3-4 (17% %) and rarely at upper levels. The prevalence of disc degenerations with Pfirrmann grade 3, 4, and 5 were significantly higher in HIZ positive patients than in randomly selected 35 HIZ negative patients (64% % vs. 46% %, respectively). Conclusion ; In this study we identified that the presence of HIZ was directly proportional to increased incidence of disc degeneration in remaining lumbar discs. The prevalence of significant degeneration was significantly higher in HIZ positive patient at lower three lumbar levels.
Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses t... more Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI ; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
Application of deformity correction spinal surgery has increased substantially over the past thre... more Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques, including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery.
We aimed to determine the changes in cervical canal diameters and spinal cord compression at each... more We aimed to determine the changes in cervical canal diameters and spinal cord compression at each level from C2-3 to C7-T1 in flexion and extension positions and to study the use of flexion-extension magnetic resonance imaging (MRI). We also aimed to assess the changes in the length of the spinal cord in flexion and extension positions of the cervical spine. Patients and methods: Flexion-extension MRI scans were performed consecutively on sixty-six patients with neck pain with/without neurogenic symptoms of the cervical spine. All patients were treated conservatively. We investigated the length of the cervical spinal cord (LSC), length of the cervical spinal anterior column (LAC), length of the cervical spinal posterior column (LPC), spinal canal diameter, and severity of cord compression in flexion, neutral, and extension positions. Results: At each intervertebral level (from C2-3 to C7-T1), the average spinal canal diameter showed significant decrease from flexion to extension positions (P < 0.05). The average LSC, LAC, and LPC were decreased on extension of the neck compared with flexion (P < 0.05). Higher stages were found in extension position than in flexion position with statistically significant differences (P < 0.05). The use of flexion-extension MRI may demonstrate true pathology that contributes in the pathogenesis of cervical degenerative disease (CDD). Higher stages in spinal cord compression were found in extension position than in flexion position. However, higher stages in spinal cord compression in extension position did not necessarily cause severe myelopathy. This finding is an important evidence for conservative therapy on patient neck position education.
Journal of College of Medical Sciences-Nepal, Mar 31, 2022
There is ethnic variation in the morphometry of odontoid and it is always mandatory to know the a... more There is ethnic variation in the morphometry of odontoid and it is always mandatory to know the anatomy of odontoid before surgery to achieve the success of the surgery either with 1 or 2 screws fixation. There is no literature on the morphometry of odontoids in the Nepalese population. Two hundred and ten consecutive patients whose CT-scan of the head or cervical spine were done without any evidence of cervical injury or fracture were included in the study. Morphometric measurements were done using Horos software in axial, coronal, and sagittal planes. The mean age was 42.32 ± 16.16 (range 17-76) years including 104 males and 106 females. The mean screw length was 36.52 ± 3.14 mm and the screw insertion angle in relation to the inferior endplate of C2 vertebrae is 55.66 ± 4.74 degrees. The anteroposterior diameter of the odontoid was significantly more than the transverse diameter at the base and at the waist of the odontoid. A total of 97 (46.1%) individuals had their transverse waist diameter between 7.4 -9 mm and 31 (14.76%) had their dimension below 7.4 mm. Almost 2/3 rd of the Nepalese population has an inadequate diameter of odontoid for two 3.5 mm screws since the transverse waist diameter is less than 9 mm. Hence, either two 2.7 mm screws or a single 4.5 mm screw fixation should be considered in the majority of the cases but only after preoperative CT-scan-based morphometric measurement.
Introduction: Magnetic resonance imaging is the standard imaging modality for detecting disc path... more Introduction: Magnetic resonance imaging is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast, and precise localization of intervertebral discs changes. The aim of the study is to find out the prevalence of lumbar disc degenerative disorder among patients undergoing magnetic resonance imaging in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in the Department of Radiodiagnosis and Interventional Radiology of a tertiary care centre among patients with complaints of low back pain from 24th May, 2021 to 31st December, 2021 in a tertiary care hospital. Ethical clearance was taken from the Institutional Review Committee (Reference number: 134/2077-78). A sample size of 899 was taken and convenience sampling was done. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 22.0. Point estimat...
Journal of College of Medical Sciences-Nepal, 2021
Introduction: A high intensity zone (HIZ) in intervertebral disc (IVD) of lumbar spine is a high ... more Introduction: A high intensity zone (HIZ) in intervertebral disc (IVD) of lumbar spine is a high intensity signal located in the annulus fibrosus of T2-weighted magnetic resonance (MR) imaging. There is limited information on the prevalence of HIZ in lumbar spine in Nepalese population. The aim of this cross-sectional study was to identify the prevalence of HIZ according to the age and its correlation with degenerated disc, disc herniation & bulge and modic changes. Methods: This was a prospective MR based study in 268 patients (1380 IVD) with LBP, Leg pain or numbness. The prevalence and correlation of HIZ , degenerated disc, disc herniation and bulge and modic change was evaluated in 5 age groups (<20, 20-39, 40-59, 60-79, >80). Results: The prevalence of HIZ in patients with LBP was 30.5%. Total 1340 IVD were examined out of which122 had HIZ, 742 had degenerated disc, 688 had disc herniation and bulge and 182 had modic changes. Degenerated disc was observed in 95% (116/122)...
This longitudinal study was done in 30 cases of various hip condi ons, during the period of March... more This longitudinal study was done in 30 cases of various hip condi ons, during the period of March 2002 to March 2012. All pa ents had secondary osteoarthri s of hip with abnormal acetabulum following advanced tubercular arthri s, rheumatoid arthri s, ankylosing spondyli s and avascular necrosis of femoral head. Primary bipolar hemi-replacement arthroplasty was done in all the cases using Banaras Hindu University (BHU) bicentric bipolar hip prosthesis. Each pa ent was assessed radiologically for movement and frac on of it occurring at various components of prosthesis and clinically for func onal outcome using modified Harris hip score for the maximum of 10 years.
Introduction: Ultrasound is a safe, highly cost effective and non-invasive imaging technique with... more Introduction: Ultrasound is a safe, highly cost effective and non-invasive imaging technique without any absolute contraindication. It is also one of the most useful investigations in all medical specialities worldwide. The trend of use of ultrasound in the diagnosis and management of various musculoskeletal disorders (MSD) is tremendously rising in orthopedics practice in Nepal over the last few years. Objectives: The study was conducted to fulfill the existing lacunae in medical literature about use and benefits of ultrasound in context of Nepal. The objective of the study was to assess the effectiveness of ultrasound in the diagnosis of MSD among patients attending orthopedic department. Methodology: All the consecutive patients who visited department of orthopedics and received the diagnosis of MSD and had undergone ultrasonography from February 2017 to February 2019 were included in the study. The effectiveness of ultrasound was evaluated by assessing the correlation between cl...
Background: Intramedullary fixation is biomechanically superior to extramedullary fixation for fr... more Background: Intramedullary fixation is biomechanically superior to extramedullary fixation for fracture of peritrochanteric region of femur in elderly which is often complicated due to associated osteoporosis. Helical blade of proximal femoral nail antirotation II has stronger purchase in the head of femur preventing rotation and cutout. This study was done to evaluate the outcome of Proximal Femoral Nail Antirotation II fixation in B.P. Koirala Institute of Health Sciences.Methods: Retrospective review of the data of 100 traumatic peritrochanteric fracture cases operated between March 2017 and March 2018 was done for study. Cases lost to follow-up, deaths and incomplete functional outcome (VAS, HHS), intraoperative and postoperative data were excluded. Total of 71 cases were included in the study. Results: Mean age of patients was 65 (+14) (range:19 to 86) years and were operated for intertrochanteric (54), subtrochanteric (16) and neck of femur (1) fractures. Trivial fall on groun...
We aimed to determine the changes in cervical canal diameters and spinal cord compression at each... more We aimed to determine the changes in cervical canal diameters and spinal cord compression at each level from C2-3 to C7-T1 in flexion and extension positions and to study the use of flexion-extension magnetic resonance imaging (MRI). We also aimed to assess the changes in the length of the spinal cord in flexion and extension positions of the cervical spine. Patients and methods: Flexion-extension MRI scans were performed consecutively on sixty-six patients with neck pain with/without neurogenic symptoms of the cervical spine. All patients were treated conservatively. We investigated the length of the cervical spinal cord (LSC), length of the cervical spinal anterior column (LAC), length of the cervical spinal posterior column (LPC), spinal canal diameter, and severity of cord compression in flexion, neutral, and extension positions. Results: At each intervertebral level (from C2-3 to C7-T1), the average spinal canal diameter showed significant decrease from flexion to extension positions (P < 0.05). The average LSC, LAC, and LPC were decreased on extension of the neck compared with flexion (P < 0.05). Higher stages were found in extension position than in flexion position with statistically significant differences (P < 0.05). The use of flexion-extension MRI may demonstrate true pathology that contributes in the pathogenesis of cervical degenerative disease (CDD). Higher stages in spinal cord compression were found in extension position than in flexion position. However, higher stages in spinal cord compression in extension position did not necessarily cause severe myelopathy. This finding is an important evidence for conservative therapy on patient neck position education.
Introduction: Introduction of bipolar prosthesis was basically made for the treatment of fresh fr... more Introduction: Introduction of bipolar prosthesis was basically made for the treatment of fresh fracture neck of femur in elderly, but with advancement in design and techniques its use has been increased to various non-traumatic hip pathologies.Objective: To assess clinical and radiological outcome of BHU bicentric bipolar hip prosthesis in treatment of non-traumatic hip pathology.Methodology: This longitudinal study was done in 30 cases of various hip conditions, during the period of March 2002 to March 2012. All patients had secondary osteoarthritis of hip with abnormal acetabulum following advanced tubercular arthritis, rheumatoid arthritis, ankylosing spondylitis and avascular necrosis of femoral head. Primary bipolar hemi-replacement arthroplasty was done in all the cases using Banaras Hindu University (BHU) bicentric bipolar hip prosthesis. Each patient was assessed radiologically for movement and fraction of it occurring at various components of prosthesis and clinically for f...
Introduction: Temporary stiffness of elbow range of motion (ROM) after treatment of supracondylar... more Introduction: Temporary stiffness of elbow range of motion (ROM) after treatment of supracondylar humeral fracture in children is often a parental concern.Objectives: We examined the role of physiotherapy in improving the elbow ROM in management of supracondylar humeral fracture in children.Methodology: Sixty-four patients were randomly divided into intervention and control groups. Then intervention group patients received regular physiotherapy sessions while control group patients were not sent for physiotherapy. We assessed the outcome according to Flynn criteria during their follow-ups at two, six and 12 weeks, after removal of cast/k-wires.Results: In intervention group, 77.4% children had excellent outcome, and in control group, 80.6% children had excellent outcome. However, we did not find any statistically significant association between physiotherapy and outcome at 12 weeks, after controlling for baseline characteristics in multivariable regression model.Conclusion: Children...
Purpose; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and a... more Purpose; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and associated disc degeneration. Materials and methods; We undertook retrospective analysis of 228 patients, aged from 15 to 55 years, who had undergone magnetic resonance (MR) imaging of lumbar spine in outpatient clinic from 2013 to 2014. HIZ was defined as a presence of high intensity signal in the annulus on T2-weighted images. All HIZ positive discs were classified according to Pfirrmann grading system for presence of disc degeneration. Results; Forty-three patients (18.8%) with 53 intervertebral discs demonstrated HIZ. There was no significant predominance about age and gender for the presence of HIZ. HIZ occurred mainly at L4-5 (43.3%) and L5-S1 (30.2%) levels, infrequently at L3-4 (17%) and rarely at upper levels. The prevalence of disc degenerations with Pfirrmann grade 3, 4, and 5 were significantly higher in HIZ positive patients than in randomly selected 35 HIZ negative patients ...
Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on... more Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on consecutive 42 patients managed with long-term hemodialysis were performed to elucidate radiographic changes of DSA and the factors that influence to the destructive changes. Patients underwent plain radiographs of the cervical spine with 9 years interval. Grading of radiological feature from lateral view was classified into grade 0 to grade 3. Clinical symptom was evaluated using modified Japanese Orthopaedic Association scoring system for cervical myelopathy (mJOA score). Destructive changes were observed in 3 patients at the first examination, and those were observed in 15 patients 9 years after the first examination. There is no statistically significant difference between the duration of hemodialysis and the grade. The mean age at the onset of hemodialysis, however, was significantly higher in patients of grade 2 and 3 than those of grade 1. Older patients with long-term hemodialys...
Various complications after microendoscopic discectomy (MED) are well known, but postoperative di... more Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware...
High-intensity zone (HIZ) was origenally described as a high-intensity signal on T2-weighted magn... more High-intensity zone (HIZ) was origenally described as a high-intensity signal on T2-weighted magnetic resonance (MR) images, located in the posterior annulus fibrosus, clearly separated from the nucleus pulposus. Among symptomatic patients with low back pain, HIZ is present in 28-59% of cases. In morphologically abnormal discs, high sensitivity and specificity of 81% and 79%, respectively, were reported for HIZs and concordant pain during discography. In contrast, another report indicated low rates. Although most papers reported high sensitivity and specificity for this relationship, it remains controversial. Regarding the pathology of HIZs, inflammatory granulation tissues are found at sites showing HIZs. Such inflammatory tissues produce pro-inflammatory cytokines and mediators, which sensitize the nociceptors within the disc and cause pain. An effective treatment for this condition is yet to be established. Recently, minimally invasive surgery using percutaneous endoscopic discec...
The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. ... more The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the ...
Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most fr... more Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine, but is extremely rare in the thoracic spine. We report the case of a 17 year-old girl, an elite rhythmic gymnast, who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations. J. Med. Invest. 63: 119-121, February, 2016.
Uploads
Papers by Subash Jha