This week started off with a focus on my research, as opposed to seeing patients. Dr. Hartl has, in my opinion, impressively logged over 1600 patients and surgeries in his tenure as a doctor. From this database, I searched for patients who had a stenosis in the spine and scoliosis, and were treated with the XLIF technique. As I searched through the database, I found that the number quickly dropped from over 1600 to a little over 50 patients, which really speaks to how novel this technique is, and how important patient selection is when considering this technique. Of those 52, only 12 of the patients had the condition I was searching for, and of those 12, I found only 8 who had had the surgery long ago enough to have at least two follow up scorings. Now, although, I have the patient data, it is now a question of how to analyze the data, and how to interpret those results, as most of the patient data is score based and every individual is different. Additionally, later this week I will be looking into Dr. Hartl's revision cases.
On tuesday, I again saw patients in the Neuro clinic with Dr. Hartl. This week the cases were more standard, and I recieved a lot more instruction on how to find stenosis and scoliosis in MRI scans, and how to determine if a disc was degenerated or bulging and pinching a nerve on a CT scan. It was surprising to me that even though sometimes the problem seemed clear on the diagnostics, much mor ewent into Dr. Hartl's decision to perform surgery than mere images. Pain and where the pain is localized played a huge decision, as well as age and other factors. Later in the week, between surgeries, we saw a young girl who had fractured a vertebrae and her primary doctor had wanted to perform surgery. However, Dr. Hartl decided it would be best to watch the healing over the span of a few more weeks and monitor pain, rather than perform a surgery that could be detrimental to her future development.
Additionally, early on in the week, we met a patient whose CT and MRI of her cervical spine showed no signs of stenosis; however, she had pain in her neck and the base of her neck, as well as a cracking/popping sound when she turned her neck one way. Dr. Hartl could do naught but tell her to rest, ice, continue to perform therapy, and maybe get a second opinion. Apparently, many patients present like this, and there is not much that can be done surgery-wise for them, at least from Dr. Hartl's position. He asked me to do a literature search about what might be the problem, and the lit. search brought me back to my undergraduate research area dealing with the facet joint. Dr. Hartl and I discussed the merits of the pain being localized at the facet, however, the reason for the sound eluded us. I looked into the research field of cavitation in the facet joint, but could not find research that linked it to the pain. Still, if the facet joint is the true culprit, RICE and therapy are the recommended treatments in the short term, which is exactly what Dr. Hartl prescribes now.
Surgery wise, this week I saw multiple discectomies and laminectomies, that usually included some sort of spine fixation with rods and screws. Additionally, I met a new vendor from TranS1, a company that focuses on spine fixation, like NuVasive, Spinewave, and Synthes Spine division. What was most striking about this meeting was the discussions between the doctors and vendors regarding the product to be used. Dr. Hartl suggested ways to improve the device and problems he encountered when using it, which were all noted by the vendors. Discussion about how to use the device more effectively and future versions of the device also followed. The most interesting case involved TranS1's AxiaLIF device, in which two large and interconnecting screws were used to fuse the Vertebrae from S1 to L4. Due to the nature of the screws, the spine could also be distracted, and x-ray fluoroscopy was used to track distension. Additionally, rods and screws were placed on the vertebrae from S1 to L4 because doctors had found that the fusion using the AxiaLIF works better when it is done in conjunction with rods and screws.
Dr. Hartl will be going to the AOSpine conference next week. I look forward to both hearing about what new happenings are going on in the fields of Spine research and Spine surgery, as well as to have a chance next week to explore other types of surgery, hopefully seeing the Da Vinci surgical device, and maybe spending a day or two in the ICU.