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Terry Streetman (Host): Welcome back to Well Within Reach, presented by Riverside Healthcare. I'm Terry Streetman, Marketing Communications representative. And we're here today with Dr. Juan Jimenez, a neurosurgeon from Riverside's Brain and Spine Institute. We're going to discuss spinal cord injuries, what they are, how they happen, and what treatment is available. Thanks for joining us.

Dr. Juan Jimenez: Hello. It is my pleasure. Thank you for having me here this afternoon.

Host: Of course. So, before we get into it, we're going to take a quick break for a message about myChart.

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Host: Okay, we're back. Dr. Jimenez, I know you've been on the podcast before, but can you give our listeners just a quick reminder of your background and what you do here?

Dr. Juan Jimenez: Yeah, I've been here at Riverside for 20 years. I'm an attending neurosurgeon, board-certified, and specializing in brain and spinal conditions, but specifically in minimally invasive spine surgery. My training, UCLA for medical school, Rush for residency, and I've been here at Riverside since completion of my residency at Rush. And I'm on staff there, but I do 99% of my surgeries here at Riverside.

Host: Well, we really appreciate having you here in the community and having this service available here that's really special for the folks who live around here. And you mentioned just a minute ago, this year marks 20 years since you started here. That's 20 years of neurological care here at Riverside Healthcare. Can you talk a little bit about the history of the program here?

Dr. Juan Jimenez: Yes, absolutely. So having trained at Rush, I was on the receiving end. I was aware Kankakee because we would get transfers. Unfortunately, at times, timing was of the essence, so we were able to help. But I was sensitized by the lack of local care in Neurosurgery.

So when I sought out positions for employment, this was a perfect match, an area without neurosurgical coverage. There had been coverage in the past, but it was intermittent and not based here in the community. I think that's been the secret sauce of our program. We are integrated here in the community. I've owned a home here for 20 years, so I think that has been important in getting our program established.

And we have grown. Just in the layout, our first office had two exam rooms and two offices, and now we're in this facility here in the Pavilion at Riverside Main Campus. We also have office space in Bourbonnais and we do satellites in Frankfurt, Watseka and Coal City. And it's not just me, but this is a team and we have my partner Dr. Zakaria, we have two physician assistants, two nurse practitioners and innumerable staff in all of our offices, helping us take care of our patients as well as our nursing staff on the hospital side, both in the ICU, the floor and where the magic happens, the operating room. So, there's been a lot of growth. There's been a lot of training, and I think it's been a beautiful journey, being here full time and catering to the needs of the community for neurosurgical services.

Host: Well, thank you for that background. And yeah, we appreciate so much being able to have this year and that team approach that you mentioned too not just the folks doing the procedures, but the folks supporting the nursing and just the whole backing of Riverside system is, I think, something that feels pretty unique for this kind of area, so that's awesome.

 So today, we're specifically talking about spinal cord injuries. Can you give a quick overview of like the spinal cord and its importance, the functions that it controls in the body?

Dr. Juan Jimenez: Yeah, the spinal cord is the continuation of the central nervous system, the brain being at the top, the command central. And then, the dissemination and reception of information runs through the spinal cord. There are parts of the spinal cord that run through the neck, chest, and lower back; in medical lingo, cervical, thoracic, lumbar, and sacral. The spinal cord basically governs the functions of our body in the arms, legs, and body itself, specifically movement, sensation, vibration, any and all movement-related activities and any and all sensation-related activities of the arms, hands, body, chest, torso, et cetera, are controlled through the spinal cord or the message is relayed. So when we want to move our hand, we think about it and the message starts in the brain. And just like an electrical system, when you flick the light on in your home, the light bulb goes on. In similar fashion, the brain generates a signal, and the movement is carried out. And the opposite is the sensation, meaning if you feel something cold, your nerves in your hands and fingers are feeling it, and that information gets to the brain. And then, it's processed and you realize this is cold or hot or whichever the sensation modality is. But simplistically, that's the anatomical, the anatomy, the nuts and bolts of the spinal cord and its basic functions that it carries out.

Host: Okay. Yeah. So, it sounds like all roads lead to and through the spinal cord. And so, an injury there obviously would be a significant deal. So, what are some of the most common causes you see for spinal cord injuries? And are there any that people may be surprised by that are so common?

Dr. Juan Jimenez: Yeah. So just, to backtrack a little bit, so spinal cord injury is a broad term, but just to establish a basic layout, there is complete spinal cord injury and incomplete spinal cord injury. Obviously, complete is the most devastating because all the signals stop going to and coming from. So, that's a very, very catastrophic in some instances. And then, incomplete spinal cord injury means that there is preservation of some degree of function, be it the movement part or the sensation part. And where it occurs, we talked earlier about the different parts of the spine, top to bottom, cervical, thoracic, lumbar sacral. So depending of the area of the spine where the injury occurs, the deficits or deficiencies that will be manifest are laid out. So if it's high up close to the head, that's the most catastrophic, because you lose everything if it's complete. If it's incomplete, then there might be partial paralysis, partial immobility, et cetera. And then, working your way down, if it's below the chest area and lower neck area, then it'll affect primarily the lower limbs. And depending, at which level will, determine the degree of deficit. And then, if it's really low, then it could involve the lower functions of the spine, which would be bowel and bladder, so just depending where the injury is at.

Now, mechanisms of injury, to address your question, most commonly is accidents, motor vehicle crashes, that is the vast majority, followed by falls and then obviously unfortunately acts of violence.

Host: Okay. So some of these obviously, you can't prevent. Are there precautions they can take or things they can do to either avoid or minimize the potential of these injuries?

Dr. Juan Jimenez: Since accidents, automobile accidents, particularly the most common, wearing a seatbelt, certainly not being jolted, tossed, or ejected. God forbid, there's some type of accident. And I always counsel my patients' posture. I think it's something simple that we can all do, not just in the setting of spinal cord injury, but in terms of spinal health. So certainly, those are simple things, low-lying fruit to do in order to potentially prevent the effects of a spinal cord injury and/or to preserve the health of the spine.

Host: Okay. So before we go on, we will take a quick break to discuss the importance of primary care.

Consistency is being able to count on someone to be there when you need them. At Riverside Healthcare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at riversidehealthcare.org/primarycare. From annual screenings to well checks and everything in between, having a primary care provider you can trust makes all the difference.

Okay, so we're back. And we're going to talk about in the event that these things happen, if someone has a suspected spinal cord injury from a fall or whatever it might be, an accident, how should someone respond to make sure that they don't make things worse and that they get care right away?

Dr. Juan Jimenez: Yeah. So, anything that compromises the neurological system is a 911, right? Top to bottom. Obviously the awareness of stroke is out there. But sometimes the spine, there's not that much awareness. " Oh, you know, I thought I slept bad," or this, or that or the other, "Oh, it'll get better." But seeking immediate medical attention and specifically with some of those signs, symptoms that we discussed, the numbness, the tingling, the weakness, et cetera. So, getting prompt medical evaluation is important, as the audience may be aware when there are accidents and the fire rescue gets there, immobilization, right? Securing the position of the spine depending on the injury is important. Because if there is injury to the spine, you want to maintain it well-aligned, such that then after proper medical and neurosurgical evaluation, the spine can be cleared. One must assume the spine is unstable until it's been thoroughly evaluated.

I hear patients that are on accidents. And then, they're like, "Well, I was feeling okay. Felt a little this, little that. And I decided, I declined being taken to the hospital. And then, they landed in my office and we realized, "Houston, we got a problem." So, certainly getting prompt evaluation is I think the most important message that the audience should take, as far as the evaluation, treatment, and potential treatment and avoidance of further injury with an unstable spine. Problems could be made worse, or the results of the injury could be made worse, if not immobilized and then evaluated.

Host: Okay. And I feel like that also speaks back to what we said earlier about the importance of having this care here in the community, that time is of the essence and getting that evaluation quickly. So, that seems like a common thread here. So if this injury occurs and someone needs treatment, what does treatment for a spinal cord injury look like in general? Is it always surgical? Are there other things that can be done depending on the severity?

Dr. Juan Jimenez: Well, by definition, a spinal cord injury means major disruption of the neural elements of the spine. So after appropriate immobilization evaluation, examination, and then the appropriate imaging-- and that is all done in the emergency room, x-rays and CAT scans are the initial screening tests that are done to determine is there disruption of the bone, is there a fracture? And then, MRI to look at the soft tissue of the spine-- if there is instability of the spine as a result of the injury, be it Injury meaning fracture or a ligament injury, so the bone could be preserved, but the ligaments are disrupted, that is an unstable spine. So if there is evidence of instability, the vast majority of the time the treatment is surgical. If there's no instability, and that's the setting where let's say the bone is disrupted, but there's no neurological deficit and no formal spinal cord injury, then bracing or immobilization, the neck brace, back brace may be the treatment. But if it is a complete versus incomplete injury, the adage now, if there is pressure on the spinal cord and nerves as a result of a traumatic injury, then aggressive, expedient surgical treatment is indicated. And the basic principle is, one, take the pressure off the spinal cord and nerves. And two, stabilize the spine. And in some instances that may require the placement of hardware to secure the spinal elements to allow the realignment if there's malalignment due to the injury and then immobilization supported by a neck brace or a back brace.

Host: That is very thorough. And good to know. So after this treatment, then someone's had the injury, they've had the evaluation and the treatment, what does recovery look like for somebody with a spinal cord injury?

Dr. Juan Jimenez: Yeah. So as we discussed earlier, if it's a complete spinal cord injury, the prospects are all negative. I've had experience where aggressive immediate decompression of a complete spinal cord injury allowed the patient with time to actually recover. Incomplete spinal cord injuries have a better prognosis of recovery.

So, it is a marathon. I prepare the patient and the family, and there are many organizations for support in the event of a catastrophic, devastating injury, like a spinal cord injury. But the initial phase is obviously the intensive care, medical treatment in the hospital. But eventually rehabilitation, I think that's where the longer term treatment is at. And then, obviously, modification to the level of activity of the patient. So, if incomplete, sometimes assist devices may be required. Sometimes if severe enough, wheelchair. And if high enough in the neck, it may require ventilatory support or a breathing machine. So obviously, I'm dating myself, but Christopher Reeve, you know, the Superman back in the day, had a high cervical spinal cord injury with quadriplegia or loss of movement of all four limbs. But he made it for a number of years. With adequate treatment, there can be supportive measures to allow the best quality of life possible given the devastating nature of a spinal cord injury.

Host: Absolutely. I think that's another place that, for me, it comes to mind, like the benefits of a system like Riverside, where we have rehab and physical therapy and occupational therapy to help with those steps along the way. So, we've talked about 20 years of Neurosurgery here, and we've got the Riverside Brain and Spine Institute. So, what makes the Brain and Spine Institute special when it comes to treating these injuries?

Dr. Juan Jimenez: Yeah. So having, obviously, experienced surgeons is very important along with our team. But the technology, I think Riverside has been very, very supportive to our program where we have state-of-the-art technology to handle these spinal cord injuries adequately and expediently.

So from a surgical perspective, we're very fortunate. Not many centers have it, but we have multiple intraoperative imaging systems that can allow us to take a very detailed picture of the spine at the time of surgery to allow the treatment. Number two, we use GPS-like technology to place the hardware and ensure the safety of the patient. And then, with our robotic platform and so-called augmented reality, it certainly gives us the best technology available to treat these injuries adequately.

Host: That's great. Yeah. The people, the team and the technology altogether, that is special. So, I guess getting toward the end here, are there any exciting developments or research happening right now, things that you see coming for the Brain and Spine Institute for these types of conditions?

Dr. Juan Jimenez: Yeah, so certainly, collaboration is important. There are, in general terms, some investigative potential treatments for spinal cord injury, through the national societies, the American Association of Neurological Surgeons, and the Congress of Neurological Surgeons, we are definitely up-to-date and well-versed on the treatments.

The spinal cord stimulation has been FDA approved as of last year for treatment of spinal cord injury, so that we currently do spinal cord stimulators for pain management, diabetic neuropathy. But that's the next iteration. Now, as I've seen in the adaptation of the FDA-approved modalities of treatment, it takes a little while. It may be approved by the FDA, but sometimes the carriers, insurance companies, there's a lag between FDA approval. But I see that as a modality that we could potentially institute to treat patients with spinal cord injury, which is basically reinstalling the electrical capability. As I mentioned earlier, it's like a light switch. You turn the light switch on and the signal goes through. So, this device provides enough stimulation to allow movement of the limb. So, it's very, very exciting technology. There are other areas of investigation that we collaborate with partner institutions and/or our societies, but those are not FDA approved yet, and certainly more to be revealed as time goes on.

Host: Well, we are basically at the end, so I'll just ask, I mean, I know we talked about one takeaway of just the urgent response, the urgent evaluation being one of the biggest takeaways. Anything else you want to add? Any other takeaways that you want for people to take with them?

Dr. Juan Jimenez: So, certainly, we want to stress to the community that we are here 24/7 and certainly getting an evaluation promptly is important. I really, really want to stress that, because I see it too often that patients come in and the evaluation was not done, and then there could be potential permanent neurological deficit. So, it's one of those things that, through this platform and educating the community, is important. So, we are happy to be here and happy to attend the community.

Host: Awesome. Well, thank you so much for all of this information and for being here. We really appreciate it. So if people would like to learn more about Riverside's Brain and Spine Institute, including our area leading stroke and endovascular neurosurgery capabilities, you can call 815-935-0750 or you can visit my rhc.net/neurosciences. And as a reminder, any sort of neurological injury, a stroke, a spinal cord injury, call 911 immediately and ask to be taken to Riverside Medical Center. So, thank you for tuning into Well Within Reach today. We're presented by Riverside Healthcare. Please take a moment to rate and leave a review for well within reach on Apple, Spotify, or wherever you get your podcasts. To learn more about Riverside, visit riversidehealthcare.org.