Interview with Hannah Johnston

Interviewer: Alex Plyler

Interviewee: Hannah Johnston

Program: Physician’s Assistant

Summary: Hannah’s project involved a case study of an individual who developed a pulmonary cement emboli after a kyphoplasty procedure (surgery that reduces pain after a fractured spine). Her role was to study the literature and develop treatment plans for this particular patient, who ended up being treated with a blood anti-coagulant.

 

1. Can you briefly summarize the purpose of your research for me?

• “I saw a patient who had a rare complication of a kyphoplasty procedure, which is a vertebral augmentation procedure to reduce pain and deformity caused by a spinal fracture. The patient developed a pulmonary cement emboli, as well as an intra-cardiac emboli […] so it’s a rare complication. My research is to read and find case reports to try to guide management strategies, because once we found it, we didn’t know exactly how to treat the patient. Patients can also present asymptomatically, […] while other patients can come in with fatal or life-threatening arrythmias that require surgical intervention. Then there’s this grey area where a patient isn’t asymptomatic, but not necessarily needing surgical intervention. We ended up treating [the patient] with anti-coagulants within the blood to reduce the risk of further embolism.

 

2. Was researching this difficult at all because of any significant gaps in the field?

• “It was a little challenging, just because it’s a rarer complication of the procedure. A majority of the literature out there is case reports and case series, so you can only utilize it with a grain of salt because that one patient could present differently from how my patient presented.”

 

3. What was the biggest challenge that you came across when conducting your research?

• “Sorting through patients that presented similarly, patients that presented differently, and just the lack of research on this given management strategy.”

 

4. What would the next steps for this project be moving forward?

• “In my research, I found one prospective study that was analyzing the incidents of the pulmonary cement emboli after kyphoplasty, and that’s how I got the rough estimate as to how common this could be. So people are studying—do you expose someone to radiation [after the procedure] and do follow up CT scans and chest X-rays? Because they could undergo radiation to [test for] this and then never have it. Of course if you do it and find that embolism, that’s good for that person. So it’s still up in the air. I also saw my patient in the ICU hospital setting, so I won’t be able to follow up with him in 6 months.

 

5. How would you summarize how your research will impact the field?

• “What’s most unique about my case is that a lot of the case reports I was reading had a certain cement they utilized in the kyphoplasty procedure. However, the [Cortoss] cement that was utilized in my patient’s procedure [only had] one other case report in which it was used. It involved cardiac embolism, so [my case] would be the first case of pulmonary embolism utilizing this Cortoss cement. It’s also unique given that a lot of the case reports utilized warfarin as an anticoagulant—we used Eliquis, or Apixiban. So we’re really just trying to broadcast another case in which this occurred, with the certain cement and our treatment strategy [for others] to compare.