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Papers by Nantawit Sugandhavesa

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2021

Talaromyces marneffei infection (TMI) causing vertebral osteomyelitis of the cervical spine is ex... more Talaromyces marneffei infection (TMI) causing vertebral osteomyelitis of the cervical spine is extremely rare. TMI in an HIV-uninfected patient is also unusual. This report presents the successful treatment of an HIV-uninfected TMI patient who underwent C6 and T1 vertebrectomies, bone grafting, and anterior cervical plating accompanied by antifungal therapy. A 63-year-old woman was diagnosed with adult-onset immune deficiency. She suddenly developed progressive neck pain without neurologic deficit. The plain radiographs and magnetic resonance imaging showed inflammation and abscess formation along the prevertebral area from C3-4 to T2-3 with vertebral body destruction. Intraoperative pus culture and tissue specimens were determined to be T marneffei. The patient was treated intravenously with amphotericin B deoxycholate for 4 weeks (0.6 mg/kg/d) and oral itraconazole (400 mg/d) for 12 months. Over a 2 consecutive year follow-up period, she achieved a full recovery with an absence of...

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015

OBJECTIVE To study the results and complications of congenital clubfoot treatment using a shorten... more OBJECTIVE To study the results and complications of congenital clubfoot treatment using a shortened (twice a week) program of serial casting using Ponseti technique. MATERIAL AND METHOD Sixteen patients with congenital clubfoot (26 feet) were treated by serial manipulation and casting twice a week until acceptable deformity correction (60 degrees of abduction with or without equinus deformity) were achieved RESULTS Seventeen patients (65%) required less than three weeks in treatment to improvement in the deformity, while eight patients (30%) required more than three weeks of treatment. This period of treatment is at least two weeks shorter than the conventional Ponseti technique. One patient did not complete treatment due to hospital-acquired pneumonia. Four patients who developed pressure ulcers from the castings were continued in treatment and all achieved successful correction. CONCLUSION A shortened program of clubfoot correction using the Ponseti technique can be effective for ...

Annals of Medicine and Surgery

Background Neglected fracture-dislocation thoracic spine without neurological deficit is an extre... more Background Neglected fracture-dislocation thoracic spine without neurological deficit is an extremely rare injury. Current studies reveal that global sagittal balance is very important for quality of life (QOL). Complex deformity causes difficulty with dissection in the surgical planning and type of spinal osteotomy. Restoration of global balance parameters are related to a successful outcome, if the surgeon understands the morphology of complex bone deformity and the surgical tactics of spinal osteotomy. Case presentation A 23-year-old female presented with untreated thoracic kyphotic deformity without paraplegia (ASIA E), following a motor vehicle accident 2 months earlier. Radiographic imaging and computed tomography scan revealed a complex fracture-dislocation at the T8–T9 level with kyphosis deformity, abnormal C7 plump line, and 65 degrees of sagittal Cobb's angle (T7–T11). The multilevel Ponte osteotomy surgical technique was performed at the apex of the kyphosis. After t...

International Journal of Surgery Case Reports

International Journal of Environmental Research and Public Health

Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing del... more Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. For each patient, specific surgical fixation, either Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. We reported the fusion rate, fusion period, and complications for each technique. Of 21 patients, 10 patients were treated wi...

Neurospine

Objective: To determine the ideal Atlas (C1) lateral mass screw placement and trajectory using th... more Objective: To determine the ideal Atlas (C1) lateral mass screw placement and trajectory using the intersection between the lateral mass and inferomedial edge of the posterior arch as an easily identifiable and reproducible medial reference point. Selection of an ideal entry point and trajectory of C1 lateral mass screw insertion can help to minimize neurovascular injuries. While various techniques for screw insertion have been proposed in the past, they all require extensive dissection of the C1 lateral mass, which can cause profuse bleeding. Methods: Ninety-three 3-dimensional computed tomography reconstructed images of C1 lateral masses in adult patients were utilized to simulate the placement of C1 lateral mass screws via 4 entry points and 2 trajectory angles referencing off of a medial reference point using Vero's VISI 17 software. The safety during screw insertion simulation, as well as the screw length, were evaluated. Results: We found that C1 lateral mass screws could be safely placed bilaterally at 3 mm lateral to the reference point in both 0° and 15° medial screw angulation without violation of the cortex. The 15° medial angulation allowed for longer (18 mm) screws than the 0° angulation. Conclusion: We recommend starting C1 lateral mass screws 3 mm lateral to the intersection between the lateral mass and inferomedial edge of the posterior arch at a 15° medial angulation.

Journal of Orthopaedic Surgery

Objectives: To summarize the current evidence on surgical treatment for large bridging osteophyte... more Objectives: To summarize the current evidence on surgical treatment for large bridging osteophytes of the anterior cervical spine from Diffuse Idiopathic Skeletal Hyperostosis (DISH). Overview of Literature: In the current review, the surgical treatment of secondary dysphagia from DISH was the most useful treatment. We propose a treatment algorithm for management of this condition because currently there are only case reports and retrospective studies available. Methods: Literature search was performed using the MeSH terms “Anterior Cervical Osteophyte,” “Diffuse Idiopathic Skeletal Hyperostosis (DISH),” and “Dysphagia” and “Treatment” for articles published between January 2000 and February 2020. PubMed search identified 117 articles that met the initial screening criteria. Detailed analysis identified the 40 best matching articles, following which the full inclusion and exclusion criteria left 11 articles for this review. Results: Incidence of secondary dysphagia was associated wi...

International Journal of Surgery Case Reports

Background: Restoration of cervical lordosis after anterior discectomy and fusion is a desirable ... more Background: Restoration of cervical lordosis after anterior discectomy and fusion is a desirable goal. Proper insertion of the vertebral distraction or Caspar pin can assist lordotic restoration by either putting the tips divergently or parallel to the index vertebral endplates. With inexperienced surgeons, the traditional free-hand technique for Caspar pin insertion may require multiple insertion attempts that may compromise the vertebral body and increase radiation exposure during pin localization. Our purpose is to evaluate the effectiveness of pin insertion aiming device for vertebral distraction pin insertion.Methods: A Smith-Robinson approach and anterior cervical discectomy were performed from C3 to C7 in 10 human cadaveric specimens. Caspar pins were inserted using a novel pin insertion aiming device at C3-4, C4-5, C5-6, and C6-7. The angles between the cervical endplate slope and Caspar pin alignment were measured with lateral cervical imaging.Results: The average Superior ...

American Journal of Case Reports

Adverse events of drug therapy Background: Hiccups induced by steroids administration is not comm... more Adverse events of drug therapy Background: Hiccups induced by steroids administration is not common. Although it is not life-threatening and is always recognized as a transient and minor complication, it can be severely uncomfortable and significantly diminished patient quality of life. In this case report, persistent hiccups were observed in 2 middle-aged Thai men receiving low-dose intravenous dexamethasone. This case report highlights the awareness of severe dexamethasone-induced hiccups. Case Report: A 49-year-old man and a 38-year-old man were admitted to our hospital and received IV dexamethasone. The hiccups started after each patient received a single dose of dexamethasone. The frequency and severity of their hiccups increased over time during dexamethasone treatment. Hiccups still continued to occur despite the discontinuation of dexamethasone and lasted for 72 h after drug termination. Conclusions: Dexamethasone can cause persistent hiccups. Although hiccups are not life-threatening, it should not be neglected since it can be severely uncomfortable and significantly diminish patient quality of life. Termination of dexamethasone can gradually relieve hiccups. Dexamethasone should be used cautiously and clinicians must be aware of this undesirable effect.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015

To study the results and complications of congenital clubfoot treatment using a shortened (twice ... more To study the results and complications of congenital clubfoot treatment using a shortened (twice a week) program of serial casting using Ponseti technique. Sixteen patients with congenital clubfoot (26 feet) were treated by serial manipulation and casting twice a week until acceptable deformity correction (60 degrees of abduction with or without equinus deformity) were achieved Seventeen patients (65%) required less than three weeks in treatment to improvement in the deformity, while eight patients (30%) required more than three weeks of treatment. This period of treatment is at least two weeks shorter than the conventional Ponseti technique. One patient did not complete treatment due to hospital-acquired pneumonia. Four patients who developed pressure ulcers from the castings were continued in treatment and all achieved successful correction. A shortened program of clubfoot correction using the Ponseti technique can be effective for correcting uncomplicated clubfoot without serious...

Singapore Medical Journal, 2013

To prevent long-term unfavourable consequences to the articular cartilage of weight-bearing joint... more To prevent long-term unfavourable consequences to the articular cartilage of weight-bearing joints, serum biomarkers can be used to identify optimum loading of activities. This study aimed to investigate the circulation pattern of serum cartilage biomarkers in healthy adults in response to an uphill walk. This study recruited 58 healthy participants for the experimental group and 24 matched participants for the control group. Participants in the experimental group walked continuously for 14 km on a pathway with a 5.97° incline, while participants from the control group walked on a horizontal pathway. Serum was collected from both groups preactivity (i.e. T1), immediately after activity (i.e. T2) and 24 hours after T1 (i.e. T3). The serum cartilage oligomeric matrix protein (COMP), chondroitin sulfate-WF6 (WF6) and hyaluronic acid (HA) levels at each time point were quantified using enzyme-linked immunosorbent assays, and the results analysed. Both groups shared similar demographic characteristics and activity duration. At T2, the serum COMP level of the experimental group was significantly higher than that of the control group, but the serum HA level of the experimental group was significantly lower than that of the control group. No significant difference between the serum WF6 levels of the experimental and control groups was observed at T2. Increasing levels of serum COMP demonstrate articular cartilage susceptibility to the increasing load. An unsustainable, high serum COMP level and an undetectable change in WF6 level were considered to be a reversible physiological change of the cartilage. A change in ser um HA level could be related to intensive physical activity and dynamic clearance rather than a change in cartilage structure.

Journal of Medical Case Reports, 2011

Introduction: Intra-cortical osteosarcoma is the rarest subtype of osseous-producing tumor. Most ... more Introduction: Intra-cortical osteosarcoma is the rarest subtype of osseous-producing tumor. Most reported cases present a low-grade histology with slow progression and good oncological control after adequate treatment. In this report, we describe a case and review the literature to propose adequate treatment. Case presentation: We present the case of a 21-year-old Thai woman who was thought to have an intra-cortical osteosarcoma of the right tibia. We performed a wide resection and reconstruction with bone transportation using an Ilizarov external fixator. The tumor recurred five years later at the same site with a similar histology. We performed a new resection and reconstruction by ankle arthrodesis with adjuvant chemotherapy. At the last follow-up, she had remained active and free from disease for seven years. Conclusion: This case report of recurrent intra-cortical osteosarcoma describes an atypical presentation. The lowgrade histology, adequate surgical margin and adjuvant chemotherapy of the recurrent lesion were favorable factors, and our patient has remained free of any tumor recurrence.

BMC Complementary and Alternative Medicine, 2002

The purpose of this study was to compare the efficacy of electroacupuncture (EA), diclofenac and ... more The purpose of this study was to compare the efficacy of electroacupuncture (EA), diclofenac and their combination in symptomatic treatment of osteoarthritis (OA) of the knee.

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2021

Talaromyces marneffei infection (TMI) causing vertebral osteomyelitis of the cervical spine is ex... more Talaromyces marneffei infection (TMI) causing vertebral osteomyelitis of the cervical spine is extremely rare. TMI in an HIV-uninfected patient is also unusual. This report presents the successful treatment of an HIV-uninfected TMI patient who underwent C6 and T1 vertebrectomies, bone grafting, and anterior cervical plating accompanied by antifungal therapy. A 63-year-old woman was diagnosed with adult-onset immune deficiency. She suddenly developed progressive neck pain without neurologic deficit. The plain radiographs and magnetic resonance imaging showed inflammation and abscess formation along the prevertebral area from C3-4 to T2-3 with vertebral body destruction. Intraoperative pus culture and tissue specimens were determined to be T marneffei. The patient was treated intravenously with amphotericin B deoxycholate for 4 weeks (0.6 mg/kg/d) and oral itraconazole (400 mg/d) for 12 months. Over a 2 consecutive year follow-up period, she achieved a full recovery with an absence of...

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015

OBJECTIVE To study the results and complications of congenital clubfoot treatment using a shorten... more OBJECTIVE To study the results and complications of congenital clubfoot treatment using a shortened (twice a week) program of serial casting using Ponseti technique. MATERIAL AND METHOD Sixteen patients with congenital clubfoot (26 feet) were treated by serial manipulation and casting twice a week until acceptable deformity correction (60 degrees of abduction with or without equinus deformity) were achieved RESULTS Seventeen patients (65%) required less than three weeks in treatment to improvement in the deformity, while eight patients (30%) required more than three weeks of treatment. This period of treatment is at least two weeks shorter than the conventional Ponseti technique. One patient did not complete treatment due to hospital-acquired pneumonia. Four patients who developed pressure ulcers from the castings were continued in treatment and all achieved successful correction. CONCLUSION A shortened program of clubfoot correction using the Ponseti technique can be effective for ...

Annals of Medicine and Surgery

Background Neglected fracture-dislocation thoracic spine without neurological deficit is an extre... more Background Neglected fracture-dislocation thoracic spine without neurological deficit is an extremely rare injury. Current studies reveal that global sagittal balance is very important for quality of life (QOL). Complex deformity causes difficulty with dissection in the surgical planning and type of spinal osteotomy. Restoration of global balance parameters are related to a successful outcome, if the surgeon understands the morphology of complex bone deformity and the surgical tactics of spinal osteotomy. Case presentation A 23-year-old female presented with untreated thoracic kyphotic deformity without paraplegia (ASIA E), following a motor vehicle accident 2 months earlier. Radiographic imaging and computed tomography scan revealed a complex fracture-dislocation at the T8–T9 level with kyphosis deformity, abnormal C7 plump line, and 65 degrees of sagittal Cobb's angle (T7–T11). The multilevel Ponte osteotomy surgical technique was performed at the apex of the kyphosis. After t...

International Journal of Surgery Case Reports

International Journal of Environmental Research and Public Health

Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing del... more Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. For each patient, specific surgical fixation, either Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. We reported the fusion rate, fusion period, and complications for each technique. Of 21 patients, 10 patients were treated wi...

Neurospine

Objective: To determine the ideal Atlas (C1) lateral mass screw placement and trajectory using th... more Objective: To determine the ideal Atlas (C1) lateral mass screw placement and trajectory using the intersection between the lateral mass and inferomedial edge of the posterior arch as an easily identifiable and reproducible medial reference point. Selection of an ideal entry point and trajectory of C1 lateral mass screw insertion can help to minimize neurovascular injuries. While various techniques for screw insertion have been proposed in the past, they all require extensive dissection of the C1 lateral mass, which can cause profuse bleeding. Methods: Ninety-three 3-dimensional computed tomography reconstructed images of C1 lateral masses in adult patients were utilized to simulate the placement of C1 lateral mass screws via 4 entry points and 2 trajectory angles referencing off of a medial reference point using Vero's VISI 17 software. The safety during screw insertion simulation, as well as the screw length, were evaluated. Results: We found that C1 lateral mass screws could be safely placed bilaterally at 3 mm lateral to the reference point in both 0° and 15° medial screw angulation without violation of the cortex. The 15° medial angulation allowed for longer (18 mm) screws than the 0° angulation. Conclusion: We recommend starting C1 lateral mass screws 3 mm lateral to the intersection between the lateral mass and inferomedial edge of the posterior arch at a 15° medial angulation.

Journal of Orthopaedic Surgery

Objectives: To summarize the current evidence on surgical treatment for large bridging osteophyte... more Objectives: To summarize the current evidence on surgical treatment for large bridging osteophytes of the anterior cervical spine from Diffuse Idiopathic Skeletal Hyperostosis (DISH). Overview of Literature: In the current review, the surgical treatment of secondary dysphagia from DISH was the most useful treatment. We propose a treatment algorithm for management of this condition because currently there are only case reports and retrospective studies available. Methods: Literature search was performed using the MeSH terms “Anterior Cervical Osteophyte,” “Diffuse Idiopathic Skeletal Hyperostosis (DISH),” and “Dysphagia” and “Treatment” for articles published between January 2000 and February 2020. PubMed search identified 117 articles that met the initial screening criteria. Detailed analysis identified the 40 best matching articles, following which the full inclusion and exclusion criteria left 11 articles for this review. Results: Incidence of secondary dysphagia was associated wi...

International Journal of Surgery Case Reports

Background: Restoration of cervical lordosis after anterior discectomy and fusion is a desirable ... more Background: Restoration of cervical lordosis after anterior discectomy and fusion is a desirable goal. Proper insertion of the vertebral distraction or Caspar pin can assist lordotic restoration by either putting the tips divergently or parallel to the index vertebral endplates. With inexperienced surgeons, the traditional free-hand technique for Caspar pin insertion may require multiple insertion attempts that may compromise the vertebral body and increase radiation exposure during pin localization. Our purpose is to evaluate the effectiveness of pin insertion aiming device for vertebral distraction pin insertion.Methods: A Smith-Robinson approach and anterior cervical discectomy were performed from C3 to C7 in 10 human cadaveric specimens. Caspar pins were inserted using a novel pin insertion aiming device at C3-4, C4-5, C5-6, and C6-7. The angles between the cervical endplate slope and Caspar pin alignment were measured with lateral cervical imaging.Results: The average Superior ...

American Journal of Case Reports

Adverse events of drug therapy Background: Hiccups induced by steroids administration is not comm... more Adverse events of drug therapy Background: Hiccups induced by steroids administration is not common. Although it is not life-threatening and is always recognized as a transient and minor complication, it can be severely uncomfortable and significantly diminished patient quality of life. In this case report, persistent hiccups were observed in 2 middle-aged Thai men receiving low-dose intravenous dexamethasone. This case report highlights the awareness of severe dexamethasone-induced hiccups. Case Report: A 49-year-old man and a 38-year-old man were admitted to our hospital and received IV dexamethasone. The hiccups started after each patient received a single dose of dexamethasone. The frequency and severity of their hiccups increased over time during dexamethasone treatment. Hiccups still continued to occur despite the discontinuation of dexamethasone and lasted for 72 h after drug termination. Conclusions: Dexamethasone can cause persistent hiccups. Although hiccups are not life-threatening, it should not be neglected since it can be severely uncomfortable and significantly diminish patient quality of life. Termination of dexamethasone can gradually relieve hiccups. Dexamethasone should be used cautiously and clinicians must be aware of this undesirable effect.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015

To study the results and complications of congenital clubfoot treatment using a shortened (twice ... more To study the results and complications of congenital clubfoot treatment using a shortened (twice a week) program of serial casting using Ponseti technique. Sixteen patients with congenital clubfoot (26 feet) were treated by serial manipulation and casting twice a week until acceptable deformity correction (60 degrees of abduction with or without equinus deformity) were achieved Seventeen patients (65%) required less than three weeks in treatment to improvement in the deformity, while eight patients (30%) required more than three weeks of treatment. This period of treatment is at least two weeks shorter than the conventional Ponseti technique. One patient did not complete treatment due to hospital-acquired pneumonia. Four patients who developed pressure ulcers from the castings were continued in treatment and all achieved successful correction. A shortened program of clubfoot correction using the Ponseti technique can be effective for correcting uncomplicated clubfoot without serious...

Singapore Medical Journal, 2013

To prevent long-term unfavourable consequences to the articular cartilage of weight-bearing joint... more To prevent long-term unfavourable consequences to the articular cartilage of weight-bearing joints, serum biomarkers can be used to identify optimum loading of activities. This study aimed to investigate the circulation pattern of serum cartilage biomarkers in healthy adults in response to an uphill walk. This study recruited 58 healthy participants for the experimental group and 24 matched participants for the control group. Participants in the experimental group walked continuously for 14 km on a pathway with a 5.97° incline, while participants from the control group walked on a horizontal pathway. Serum was collected from both groups preactivity (i.e. T1), immediately after activity (i.e. T2) and 24 hours after T1 (i.e. T3). The serum cartilage oligomeric matrix protein (COMP), chondroitin sulfate-WF6 (WF6) and hyaluronic acid (HA) levels at each time point were quantified using enzyme-linked immunosorbent assays, and the results analysed. Both groups shared similar demographic characteristics and activity duration. At T2, the serum COMP level of the experimental group was significantly higher than that of the control group, but the serum HA level of the experimental group was significantly lower than that of the control group. No significant difference between the serum WF6 levels of the experimental and control groups was observed at T2. Increasing levels of serum COMP demonstrate articular cartilage susceptibility to the increasing load. An unsustainable, high serum COMP level and an undetectable change in WF6 level were considered to be a reversible physiological change of the cartilage. A change in ser um HA level could be related to intensive physical activity and dynamic clearance rather than a change in cartilage structure.

Journal of Medical Case Reports, 2011

Introduction: Intra-cortical osteosarcoma is the rarest subtype of osseous-producing tumor. Most ... more Introduction: Intra-cortical osteosarcoma is the rarest subtype of osseous-producing tumor. Most reported cases present a low-grade histology with slow progression and good oncological control after adequate treatment. In this report, we describe a case and review the literature to propose adequate treatment. Case presentation: We present the case of a 21-year-old Thai woman who was thought to have an intra-cortical osteosarcoma of the right tibia. We performed a wide resection and reconstruction with bone transportation using an Ilizarov external fixator. The tumor recurred five years later at the same site with a similar histology. We performed a new resection and reconstruction by ankle arthrodesis with adjuvant chemotherapy. At the last follow-up, she had remained active and free from disease for seven years. Conclusion: This case report of recurrent intra-cortical osteosarcoma describes an atypical presentation. The lowgrade histology, adequate surgical margin and adjuvant chemotherapy of the recurrent lesion were favorable factors, and our patient has remained free of any tumor recurrence.

BMC Complementary and Alternative Medicine, 2002

The purpose of this study was to compare the efficacy of electroacupuncture (EA), diclofenac and ... more The purpose of this study was to compare the efficacy of electroacupuncture (EA), diclofenac and their combination in symptomatic treatment of osteoarthritis (OA) of the knee.