Monday, July 12, 2010

Week Four: Change of Pace

This week, Dr. Hartl attended the AOSpine Conference in Montreal, so I took the opportunity to continue working on my research project and explore other surgeries.

Instead of continuing work on the XLIF cases, as Dr. Hartl was away, I looked into Dr. Hartl's revision cases. As with last week, using certain surgical codes, I whittled Dr. Hartl's list of over 1600 patients to around 50 revision cases he had performed. Revision cases are usually defined by a failure of instrumentation or failure for a bone graft and fusion to take, and we are particularly interested in the failure of instrumentation cases. By narrowing down these failures, we can calculate complication rates based on type of surgery, data that will at least be useful for Dr. Hartl to know. Later in the week when Dr. Hartl returned from the conference, we discussed the cases, and came up with a list of other data I would later add to his database. This data will be part of a much larger database used for his other retrospective studies. Additionally, looking at complications in spine surgery is giving me a greater appreciation for where my own research may fit in. In some cases, an intervertebral disc replacement would be a perfect supbstitute for current techniques, especially in younger patients.

On wednesday, I was given a chance to see a Prostatectomy performed by Dr. Douglas Scherr. Dr. Scherr is part of the Urology department at NYP, and has an appointment as a professor in the medical college. His clinical expertises include kidney, bladder, testicular, and prostate cancer; basically, the field of Urologic oncology. Additionally, he is quite well known for being a major proponent of robotic surgery using the Da Vinci Robotic system. This was quite the experience on many levels. I both got a crash course education on urologic anatomy as well as a lesson on how robotic surgery worked. One thing of note was that, I had not previously known other doctors are required to help the one doing the robotic surgery by assisting with smaller arms. In this surgery in particular, various samples were taken around the prostate and sent to pathology to determine whether the patient had cancer or not. Additionally, it was interesting to be able to watch the whole surgery from start to finish on a television screen. Finally, the meaning of minimally invasive was redefined for me. I had seen minimally invasive spine surgery, even those require incisions that were larger than what was needed for the Da Vinci. It is truly a marvel of modern medicine. More information and videos of his surgeries can be found here:

Toward the end of the week, I did get to see a new, interesting spinal surgery. The procedure was a fusion of the L2 - S1 vertebrae, however, it was done without instrumentation. It involved a laminectomy at those levels, and the use of actifuse bone graft to aid in the fusion. After the surgery, the patient would have to lay flat for a while to ensure the fusion took. I had not seen a fusion attempted without instrumentation, and found it quite interesting. It was made even more interesting due to the state of the patients spine. The degeneration was so advanced that part of the dura that protected the spinal cord had worn away. Dr. Hartl stitched the dura closed, and then in coordination with the anesthesiologists, a Valsalva maneuver was performed. A Valsalva maneuver increased intraspinal pressure and helped to identify any leaks in the dura before the final layers of bone graft were used. I am currently collecting more literature on the maneuver so I can figure out exactly how this works.

Our MRI class was canceled due to equipment being down. I hope that next week, we will be able to get to learn how to perform an MRI. Additionally, I plan on further discussing the research project with Dr. Hartl, and maybe even getting into the Emergency room as a change of pace.

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