Week 6: Un Cubano en Nueva York

Josue Santana

It is hard to believe that we are almost at the end of the Summer Clinical Immersion Program. It feels like yesterday where I was running all over the hospital to get the security clearance to do my clinical project, access the hospital, and watch surgical procedures. Throughout this week, I worked primarily in my retrospective clinical research study. We finally completed the portion of the study where we searched for multiple demographic and skeletal-specific factor on the patient’s medical history. Our preliminary results look quite promising, and I am thrilled to run the statistical analysis of our data on the first days of the upcoming week. From our patient’s cohort, the biggest reason for a surgical revision after a total knee replacement was infection followed by instability, aseptic loosening, stiffness, and periprosthetic fracture. This preliminary finding is quite outstanding because it reinforces the importance of having rigorous protocols not only within the operative room but throughout the entire hospital to avoid episodes where the patient’s life can be compromised. Furthermore, we are also optimistic to elucidate the role of demographic factors such as age, gender, and body mass index in the bone quality and quantity of the patient.

On Tuesday’s morning, I met with Dr. Matthew Korf and Dr. Sarah Pownder who are experts in the field of MRI. Both are clinical researchers at HSS having long-lasting collaborations with our research lab at Cornell University. Most of our conversation was pertaining to our current research project involving bone marrow lesions. At the end of our meeting, they gave me a tour of the MRI facility explaining me the functionality and clinical purpose of their 1.5 & 3-Tesla MRI machines. One case was particularly interesting where a claustrophobic patient was having an MRI of his entire spine. In such cases, the imaging technician provides the patients with MRI non-magnetic prism glasses where they see the outside of the room rather than the bore of the magnet. Lastly, I was fascinated with the work of Dr. Pownder and her expertise in the field of veterinary imaging. We had a brief discussion where I learned how there is a strong need for better imaging guidelines and protocols to perform MRI procedures on animals. She has been a monumental person in the field by adapting multiple protocols and imaging procedures originally intended from human patients into a much smaller scale suitable for animal models. 

On Tuesday’s afternoon, I shadowed Dr. Kim on the OR during a procedure where the patient was diagnosed with cervical myelopathy. It is a condition where there is a narrowing of the spinal canal ultimately causing physiological complications often in the form of spinal cord compression. The surgical procedure was quite extensive since the surgeon had to operate the patient from both, the anterior and posterior position. I was mainly interested in the anterior cervicothoracic fusion since it was undoubtedly the most challenging portion of the surgery. There are multiple anterior surgical techniques in to reach the cervicothoracic spine. Dr. Kim decided to use the supraclavicular approach. The main deciding factors for this procedure is that it tends to be simple and less traumatic for the patient. His decision was based on pre-operative imaging of the patient’s cervical and thoracic spine. Throughout multiple visits to the OR, I have been able to observe how orthopedic surgical equipment can change dramatically depending on the area of the body. Also, it has been great to witness the versatility of surgeons to treat patients where sometimes a well-established procedure may not be optimal due to pre-existing diseases or other complications such as allergy to certain anesthetic medications.

Lastly, I met with Joseph Lipman who’s one of the lead engineers at the Department of Biomechanics at HSS. We discussed ways in which the insertional torque can be measured, when polyaxial pedicle screws are inserted into the pedicle of the vertebrae during spinal fusion procedures, using a calibrated torque wrench. Lipman is collaborating with Dr. Stein in another clinical study.

I am truly satisfied with the results of my clinical research project as the Summer Immersion Clinical Program comes to its end. Over the course of the last week of the program, we intend to finalize our statistical results, begin analyzing our findings and set the foundations for additional clinical studies along the way.