July 25, 2014 by Jithin Thenasseril
Two medical research studies by resident physicians at Monmouth Medical Center received the top award in the 2014 Ellen M. Cosgrove, M.D., Housestaff Research Awards competition for advancing medical and surgical knowledge. The two studies received the Award for Overall Excellence, which was shared among orthopedic residents Adil Samad, Alexander Willis and Jigar Chauhan.
Monmouth Medical Center, located in Long Branch, N.J., is one of the state’s largest teaching hospitals and an academic affiliate of the Drexel University College of Medicine. It has been recognized as a leader in surgical advancement and was the first to introduce robotic surgery and other medical techniques to the region.
Samad and Willis received the Award for Overall Excellence and the F&J Orthopaedic Award for their paper titled “Radiographic Fusion of Multi-Level Anterior Cervical Decompression and Fusion with PEEK Interbody Implants and Local Autograft.” The study was mentored and co-authored by spine surgeons Steve J. Paragioudakis and Jason D. Cohen and radiologist Andrew Kwak.
The aim of the study was to assess how quickly multiple vertebrae in the neck fused together after undergoing a surgical procedure called “multi-level anterior cervical discectomy and fusion”. ACDF is the removal of spinal discs located between the separate vertebrae in the neck and may be necessary for several reasons, one of which is a herniated disc.
The study looked at the rate of bony fusion in the neck vertebrae when several discs were removed and replaced, as opposed to one or two. The aim of the study was to disprove the assumption that as the number of operated discs increased, the rate of fusion decreased.
“We chose to work on this project because there is limited data demonstrating fusion rates in multilevel ACDF”, Willis wrote in an email. “Historically, evidence has shown that as the number of operated discs increased, the rate of fusion tends to decrease. Some articles suggest that to improve radiographic fusion rates, a multi-level ACDF should be combined with a posterior cervical procedure. However, posterior cervical surgery is associated with a high rate of complications such as infection. Our goal was to challenge this notion and demonstrate that the technique utilized at our institution would show high rates of fusion with multilevel ACDF.”
The unique technique utilized at Monmouth uses interbody devices made of polyetheretherketone packed with local autograft bone from the vertebrae, rather than the hip, which was the standard practice for a long time. Once a patient underwent the procedure, the patient’s follow-up X-rays were examined four to eight months after the surgery by a radiologist to determine if fusion had occurred.
The radiologist was unaware of which patients underwent the procedure and which didn’t, to avoid bias. The results of the study showed that multilevel ACDF is associated with a high level of fusion when used with PEEK interbody implants and local autograft and that the technique is safe and effective.
The Award for Overall Excellence was shared with pediatrics resident Jigar Chauhan at The Unterberg Children’s Hospital for his paper titled “Improvement in the Timing of Administration of Antibiotics to Neonates with Suspected Sepsis.” The study was mentored and co-authored by pediatrician Richard DeGroote.
The study looked at ways to reduce delay in the initiation of antibiotic treatment to newborn infants suspected of having sepsis, a potentially life-threatening medical condition associated with bacterial infection. Newborn children are highly susceptible to infection and the symptoms associated with the condition are often non-specific and subtle, which delays the identification and treatment of the illness.
The identification process involves obtaining a blood, urine, and spinal fluid sample, which can take up to 30 to 45 minutes under the best conditions. After the infection has been identified, the administration of antibiotic treatment can take up to four to five hours after the symptoms presented. The delay leads to high infant mortality and morbidity rates, and the study provided solutions that streamlined the process for administering antibiotics at Monmouth to newborn children suspected of having sepsis.
The Housestaff Research Awards competition is held annually to promote academic and clinical growth and to reward scholarly activity in 14 categories among 107 residents. The awards were presented to the residents June 5 at ceremony, during which the recipients gave a presentation about their studies to an audience of other award winners and attending physicians from all departments at Monmouth.