This week was relatively uneventful but hopefully I can remedy that next week. I went to a surgery, went to a meeting and worked on my research this week and that was all. I got sick midway through the week and due to concern for possibly infecting coworkers and patients I stayed in bed and rested for a couple days which caused me to miss several interesting procedures and meetings.
The surgery I saw was a scoliosis repair surgery on a 15 year old girl. She was approximately 47 kilograms according to her charts which is about 104 pounds for my American readers. I would judge she was about 1.57 meters tall or 5' 2" for my American readers. This means she was much younger and much skinnier than any of the previous surgeries I had seen. Due to the type of surgery, the age and the weight of the patient, this surgery was much different than the previous fusion surgeries I had seen. The first difference was the size of the incision which was much larger for this scoliosis repair and covered up approximately the entirety of her back (they were adjusting t2-l4 which is from about your chest to the top of your butt). The second difference was the depth of the incision which was much shallower for this younger and skinnier patient. It seems that as we get older and fatter we build up a layer of muscle and fat that covers our spine. This second difference expedited the procedure even though the dr needed to the implantation of many more screws. The third difference was the type of screws that were used for this procedure. During all the disc replacement procedures, the dr implanted bars and screws in the back to ensure fusion, however, those screws where different. In the disc repair surgeries, the screws had a set screw that held the bar in place. In the scoliosis repair, the screws had a collet type design that allowed part of the screw to be pulled up and tightened into place to grip the bars. I talked to the rep in the surgery room extensively about the tools and screws that are used in this procedure and I was impressed about the foresight that goes into their design. He also mentioned additional improvements that they were working on for both the tools and the screws and bars that are implanted. One foresight that I was very impressed with was a series of tools that would both tighten and loosen the grip of the screws on the bar to a specific percentage. Other than the differences there were several parts of the surgery that I found interesting. The first was how the surgeon bent the bars that would essentially become the new shape of the girl's spine. He bent the bars into shape based off of eye balling angles which I found very interesting. I would expect that they would have created a computer model based off of the images of the spine to determine the lengths and curvature that needed to go into the new spine's shape to ensure a proper kyposis and lordosis angle, but it seems that the experience of the surgeon is all that is needed for this step. Although I was told by the rep that they provide additional rods, in case the surgeon accidentally removed too much of the rod while shaping it. Another interesting part of the surgery was the during surgery imaging that went on. Normally during the spine surgeries that I have seen, they will call in an imaging technician and they will take two fluoroscope images, however, since this surgery covered such a large portion of her back they took x-ray images and have to develop them during the surgery so that they surgeon knew if he was correct in all his placement. Overall this surgery took about 7 hours and was the easiest one for me to see what was going on. I've discussed it with my mentor and I believe I am going to try to see other types of surgeries from now on since I've seen a wide range of spine surgeries already.
The meeting I attended was about the effects of mechanical loading on acl repairs which I found interesting but difficult to speak up and ask questions. The presentation covered one of the researcher's techniques for examining acl repair in rats. I had several questions about his loading technique and data, however due to the questions of the rest of the people present I was unable to ask them. In general my concerns with the research were that his load cell was positioned in such a manner that its readings wouldn't give a good representation of the loading that was occurring. His data seemed to agree with my concerns since the load cell should have only been reading the tension in the acl during the loading of it, however it was negative several time implying compression which doesn’t make sense. Also some of his graphs were confusing due to using units of gram forces and having several different zeros on the same axis with multiple data readings all put together.
My research is going smoothly for now. I have been checking the image processing code that I wrote and found that it needed some modifications. I was comparing my results to images scored by another person and found that my program calculates cells approximately 20% differently than they did but on the overall from what I've looked at I agree with my program's results over the person's scores. I still need to discuss this with my mentor but I believe this portion of the project may be done and I plan to expand the project to incorporate some of the skill set I have picked up in my work at Cornell.
Well sorry for the long winded post again, but I guess I had a lot to talk about even though I got sick this week.
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