Transcription:
Innovations in Spine Surgery

Carl Maronich (Host):  Welcome to the podcast. We are joined by Dr. Juan Jimenez. Dr. Jimenez is a neurosurgeon with the Riverside Neurosciences Institute. Dr. Jimenez, welcome to the podcast.

Dr. Juan Jimenez, MD (Guest): Oh, thank you very much Carl. It’s a pleasure to be here.

Carl:  Well, we appreciate you joining us. And I know you have been at Riverside now about 12 years.

Dr. Jimenez:  Yes, we started the practice here in 2005, believe it or not. So, it will be our 13th year anniversary this summer. My partner and myself, we have been here since 2005.

Carl:  And done some great things in that time. You don’t probably have a list of all the accolades you have won over the years, but there have been a number of them.

Dr. Jimenez:  Yeah, certainly it has been a true honor to be in this community. Very briefly, having trained at Rush University in Chicago, we would receive patients from Kankakee and being able to afford neurosurgical coverage in this community was dear to my heart, having been receiving patients from this community and over the years we have been blessed with a growing practice and those accolades, quality is I think the one and foremost definition of our practice and our brand and over the years we were designated 2011 for the entire state, number one in spine surgery, Health Grades has recognized us both for the neuroscience component and spine surgery component. So, it has been very, very rewarding to provide outstanding care here in the Kankakee Valley community.

Carl:  And originally from California?

Dr. Jimenez:  Yes, yes. People ask me what are you doing in Illinois? But I was originally born here in the Midwest, did all my training in southern California and did my stint in Miami for my internship, residency as I mentioned previously at Rush University in Chicago; but I have a family and being able to raise a family here in the Midwest has been great.

Carl:  A family that has changed a lot in twelve years. The kids aren’t little anymore.

Dr. Jimenez:  No, no, no. they are full grown. My oldest is an art therapist, my son is in the medical device sales and I have my son at UIC and my youngest, he’s 18 going to Loyola, so certainly we are grounded here in the Midwest at Chicagoland in particular.

Carl:  Oh, well that’s great. Maybe we should let folks know for sure al that a neurosurgeon does. You mentioned spine which is a specialty. But there are other components to neurosurgery. Really, it’s brain and spine surgery.

Dr. Jimenez:  Absolutely. Yes, the general concept of neurosurgeon is that of a brain surgeon, but certainly in a community practice like here at Riverside Medical and in Kankakee; we provide a full gamut of neurosurgical procedures so from the top to the bottom, yes. Brain surgery, brain biopsies, we do brain biopsies again for cancer patients, we have state of the art equipment here in the community at the Cancer Center to do radiosurgery which is treatment of brain tumors without open surgery. So, that talk about non-invasive or minimally invasive. This is truly noninvasive technology that has been here in the community since 2013. My partner has a specific interest in vagal nerve stimulators, those devices get placed in the neck to help control seizures. I have a particular interest in spinal cord stimulators which are placed in the spine for pain procedures. And also, within the nervous system are the peripheral nerves. So peripheral nerves can be treated say like a carpal tunnel and believe it or not, we have treated spinal and peripheral nerve tumors which are again present in the community and we can treat them locally and along with the degenerative treatment, those conditions of wear and tear; we also provide treatment for trauma and that involves again spinal injuries, brain injuries, concussion, traumatic brain injuries, traumatic hemorrhage, hemorrhagic stroke, so you name it and we are well versed and capable of treating a vast majority of patients that arrive to our emergency room in trauma situations.

Carl:  Alright, so especially important to have that in the community for those kinds of things in particular so they don’t have to be flown out or sent out to other facilities, we can do that right here saving time.

Dr. Jimenez:  Absolutely and that’s the key. Timing is of the essence. As I mentioned earlier, I was on the receiving end at Rush and sometimes transfer, making the phone calls, getting the patient, sometimes it was a little too late and there could potentially be irreparable damage. So, having care locally I think it’s critical for the well-being of the community and like I mentioned in the minority of the cases where either because of equipment or additional expertise required to treat some neurological conditions; we have a direct link and connections particularly with Rush to get patients transferred expediently if necessary.

Carl:  Right, but as you said earlier, spine surgery an interest of yours. And there are a lot of innovative things being done, many of them being done right here at Riverside.

Dr. Jimenez:  Absolutely. One of the great aspects of this organization has been the support of our practice and to that end; being involved in investigations and research. My partner and myself we both have been involved in the research component of implants and the key hot topic right now in spinal care is surface technology. So, for the last couple of years, we have been implanting devices for the lower back for disk replacement, for fusions and that’s the titanium 3-D printed devices. More recently, we have been looking at adapting porous meaning think of it like a coral or a sponge where there are devices that can be implanted into the spine and because of porous nature, like a sponge; the literally get absorbed and integrated and help promote the healing of the bone in spinal procedures. So, certainly those technologies are here in the community and one has to be fiscally responsible also so certainly having competition in the implant device world allow us to bring the latest technology to the community and not break the bank so to speak. So, we can innovate and stay current with all those technologies that are out there, but we don’t just implant everything that’s out there. We are very selective, very judicious, we look at the basic science. Does it make biological sense and so far, what we have evaluated and implanted; has had outstanding outcomes.

Carl:  Now I guess not every patient is a candidate for some of these kinds of things. So, is there a process candidates or individuals go through to determine if some of this new technology is applicable in their situation?

Dr. Jimenez:  Absolutely, absolutely. And one has to look at the root cause of the problem. One has to look at the age of the patient and one has to look at the comorbidities and risks. Now, as a whole, we are a very conservative practice. So, we try the nonsurgical treatment options first. And if those do not render a benefit to the patient; then we talk about surgical options. So, just briefly, as an example, a young patient with say a disk of the neck or the lower back that does not respond to al the forms of conservative treatment; the procedure of choice would be an artificial disk. And through those technologies one can preserve the movement of the spine, minimize those effects of fusion and allow a superior device to be implanted and we have been doing artificial disk technology for literally ten years. And we are patient advocates. Sometimes we have to arm wrestle the insurance company but if we strongly feel that the technology is indicated for the patient; we will advocate, we will call, we will do the so-called peer to peers, we have to call a doctor from the insurance company and convince them that we have a sound argument wanting to offer the best treatment option for the patient.

Carl:  Which is about getting the patient back to doing the things in their life that they want to do and they should be able to do.

Dr. Jimenez:  Yeah, one of the phrases I hear repeatedly through my patients is doc, you gave me life back. And that’s a real motivator, up lifter for me, rewarding because we are built to move and when someone is in intractable pain, does not move, a series of complications follow. And those can include a blood clot, a pneumonia, an infection, a sore, from immobility and those can potentially be fatal. You know patients can die from these complications of lack of mobility. So certainly, restoring function, restoring mobility is important for our patients and we take that very seriously. And we will advocate and promote those technologies that are indicated for the particular patient based on their needs.

Carl:  Taking trauma aside, are there other states, conditions, that would get somebody needing back – I was just basic anatomy. Some people are created slightly differently with over time, I am sure their spine works a way that isn’t ideal. So, you have to do something in that case. But we probably as people sometimes, maybe are carrying too much and that throws the spine off so there are other conditions that could affect the back and the spine?

Dr. Jimenez:  Absolutely.

Carl:  I guess you see the gamut of that in your practice.

Dr. Jimenez:  Yes, yes and then we really try to promote healthy habits and we have had the development of the Spine Wellness Program through our fitness center on our north campus and certainly incorporating aquatic therapy, exercise therapy and a whole host of noninvasive treatments that may help, nutrition counseling, certainly all of these factors and in some instances, working with our medical colleagues to determine shall we treat the medical condition first, let’s say is affecting the metabolism or is affecting the cardiac function so that we treat the patient from a neurosurgical perspective, however, we have to have a holistic approach and look at the entire patient and within our rapidly growing Riverside Medical Group; we have subspecialties that can help us treat patients again, locally for their underlying conditions that may need to be optimized prior to say to a surgical intervention if deemed indicated.

Carl:  Right, you talk about the implantable devices, the 3D printed implantable devices, some very porous so they work well being absorbed into the body and that. What other innovations are you seeing that will be either are or will soon be available at Riverside?

Dr. Jimenez:  Yeah, I think the adaptation of these 3-D printed devices for the neck or cervical spine that has been rolled out this past year. And again, we have incorporated the technology and have seen excellent outcomes. When we look at the process of surgery and the processing of materials, looking at disposable implantation tools that A, decrease the amount of work that is done in preparation for the surgery by our staff and more importantly, decrease cost. I think those are the two variables that we have to look at today’s day and age. Quality and cost.

Carl:  Oh sure. And what are those tools specifically. Are those the tools that you are using or are those the devices that are implanted or what...

Dr. Jimenez:  No, it’s the actual tools that we are using. So, as an example. If we are going to do say a cervical disk repair with a reconstruction, an anterior cervical discectomy and fusion, a very common procedure. Typically, there has to be a tray for the sizes, the so-called trials and then another tray for the plates that help for the reconstruction and another tray for the implantable screws, so imagine, that’s five, six, seven. In one case there were 19 trays that had to be processed. This means that they have to get sterilized, they have to be inspected. They have to be processed and that’s energy that’s used, that’s labor and that adds a lot more scrutiny and potential deviations of say sterility. When we can bring in one simple small package, the key instruments that are needed that need not go through a processing in-house, it really reduces that labor and that preparation for the surgery. And the beauty is that we can incorporate that by having a reduction in overall costs and I think again, that’s win-win. And we have implemented that for both cervical surgery as well as lumbar or lower back surgery, neck and lower back.

Carl:  Great innovation. And helps all the way around it sounds like.

Dr. Jimenez:  Yeah, I think we have to be good stewards of our resources. As it stands today you know our healthcare formula for funding is not sustainable, so we are being innovative and thinking ahead to that overall healthcare cost reduction.

Carl:  And with the implantable devices that we just talked about; the patient recovery and what happens to the patient after the surgery with their recovery. Do you see a difference with that technology then than the older technology?

Dr. Jimenez:  Yeah, I think I’ll take one step back and you know we have been doing minimally invasive spine surgery for the last 12 + years. So, that in and of itself reduces hospital stays, it reduces blood loss, gets the patient mobilized faster. With the newer 3D printed devices, the body absorbs them, incorporates them faster, therefore, instead of having to wait eight weeks for the patient to get back to their activities, we can do that at four to six weeks, meaning that the healing of say a lower back and or a neck reconstructive procedure or fusion; the patient can be mobilized, can start therapy, get back to work and activities sooner than say with a traditional devices.

Carl:  Yeah, that’s great for everybody. How wonderful. Well Dr. Jimenez you have talked about a lot of interesting things that are going on at Riverside. You could probably talk about a lot more and spend another hour with us. But we do look forward to having you back another time to talk about some of those and some future innovations that aren’t that far in the future for Riverside.

Dr. Jimenez:  Absolutely. I’ll just give you a teaser, you know another very, very, very hot topic in spinal surgery is that of robotics and we have partnered with a company that we have several of their platform devices, I mentioned earlier we have radiosurgery and that’s the True Beam system. We have partnered with Brain Lab for intraoperative CT as well as our intraoperative navigation. These are tools that allow us to image the spine at the time of surgery and use a GPS like system. Well, the next generation of that platform will be a robotic component that – I will leave it at that and give you more exciting details on our next conversation.

Carl:  We look forward to that. Dr. Juan Jimenez, we appreciate your time with us on the podcast and for more information you can go to the Riverside website and learn more about all the great things happening in neurosurgery.

Dr. Jimenez:  Carl, thank you very much. It’s been a true pleasure.

Carl:  Thank you doctor.