Medical Student Research Fellowship for Summer 2007

Mentor: Daniel J. Sucato, MD MS
Department: Orthopaedics
Room number: Texas Scottish Rite Hospital, 2222 Welborn St, Dallas, TX 75219
Mail Code: n/a
Phone number: 214-559-8471 (Summer Student Coordinator)
E-mail: dan.sucato@tsrh.org, tara.kristof@tsrh.org (Coordinator)
Project title: Radiographic Outcome following Steel triple innominate osteotomy (STIO) for the management of residual developmental dysplasia of the hip (DDH)

Human subjects IRB approved project number (where applicable): 062006-009

Animal subjects IRB approved project number (where applicable): n/a

Project Type: Patient-based retrospective research

Brief Description of Project:
Purpose: To add radiographic information to a database that has already been created and a paper that has been presented previously.(RAP# 04-00-474, IRB# 0101-036). This will add the following information: transverse analysis to determine version of the acetabulum and to correlate this radiographic information with the functional outcomes scores.

Description of Proposed Research: This study will build on a previously approved and as yet unpublished study at the Texas Scottish Rite Hospital for Children which assessed function after Innominate Pelvic Osteotomy in Patients with Dysplasia of the Hip. This study is necessitated to complete the outcomes assessment of the aforementioned study by including an assessment of acetabular version using both the cross-over sign and posterior wall sign (Reynolds et al., 1999) and permit publication. These version parameters will then be analyzed to determine their influence on the Harris Hip scores previously obtained. This will be all done retrospectively and the radiographs which were obtained at the time of the latest followup to include the AP film will be used to measure the cross-over and posterior wall signs.

Project title: Spinal Cord Monitoring in Patients Undergoing Surgery for Scheuermann's Kyphosis

Human subjects IRB approved project number (where applicable): We are in the process of submitting. The project will be approved by the summer.

Animal subjects IRB approved project number (where applicable): n/a

Project Type: Patient-based retrospective research

Brief Description of Project:
a) Specific aims. 1) To determine the ability to obtain the baseline SSEP and MEP in patients undergoing surgical treatment of Scheuermann's kyphosis. 2) To determine whether baseline studies remain consistent throughout the surgical procedure for SSEPs and NMEPs. 3) To determine the false-positive and false-negative rate in patients undergoing surgical treatment for Scheuermann's kyphosis. These specific aims will be studied in the Scheuermann's kyphosis patient population, and will be compared to a cohort of adolescent idiopathic scoliosis patients who are operated on during the same time period.

b) The design of the study: This will be a retrospective chart review of patients who had spinal cord monitoring for Scheuermann's kyphosis from 1993-the present. During this period of time spinal cord monitoring has been very consistent regarding equipment utilized, as well as the personnel and the neurology staff supervision. Two groups of patients will be analyzed and compared: the patients undergoing operative treatment for Scheuermann's kyphosis and patients undergoing posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.

Baseline monitoring will be assessed and standard criteria as to good baseline values will be determined. False-positive and false-negative rates will be identified through the medical record. A careful evaluation of the detailed record from the spinal cord monitoring team, as well as the operative note to determine responses to any changes within the spinal cord monitoring will be evaluated.

Comparison between the Scheuermann's kyphosis patients and the patients undergoing surgery for AIS will then be determined using standard statistical methods.

We anticipate approximately 100 patients with Scheuermann's kyphosis and will have a comparison group of AIS patients in a 1:2 ratio so that the number of patients in the AIS (control group) will depend on the number of Scheuermann's patients.

c) Anticipated results: The success of obtaining baseline SSEPs and NMEPs is anticipated to be very similar to AIS patients. Changes during the surgical correction of the Scheuermann's kyphosis, however, may be greater than patients undergoing AIS surgery. The incidence of false-negative and false-positive results should be low in this patient population, given the state of the art spinal cord monitoring that is here at TSRH. Important information with respect to the response (by the surgeon and anesthesiologist) to changes in spinal cord monitoring will be important to understand in this patient population.

Previous Research Activities or Publications with Medical Students:
Sucato DJ, Andrade NS, Moore W, Ross Ward D. Lateral vs. Cross Pinning for Supracondylar Humerus Fractures: A Large Single Institution Study. Paper Presentation at the 73rd Annual Meeting of the American Academy of Orthopaedic Surgeons, Chicago, IL, March 2006.

Sucato DJ, Erken H, Gonzalez J, Comparison of Thoracoscopic Anterior Spinal Fusion with Posterior Spinal Fusion for Lenke 1A Thoracic Adolescent Idiopathic Scoliosis. Podium submission to the Scoliosis Research Society Annual Meeting, 2007.

Return to Medical Student Research Page