The Spine Pod

The Spine Pod A podcast about all things Spine Surgery. For educational purposes only & does not constitute as medical advice.

Available on:
YouTube, Spotify, and Apple Podcasts

09/15/2026

When you have chronic back pain, figuring out what is causing that pain can sometimes be surprisingly difficult. There are a lot of pain generators in your spine that could be responsible, and for a long time the disc itself wasn't widely counted among them. If you've been told there's no clear source for your pain, that history may be part of why.

Dr. John Peloza, an orthopedic spine surgeon, disagrees with the idea that a disc can't be a source of back pain. Many spine specialists were trained that back pain can only be associated with the compression of nerves. Dr. Peloza’s position is different. He believes the disc can generate pain on its own, that discogenic pain is a common driver of axial back pain, and that spine surgery can treat it successfully.

This is not a debate about whether your pain is real. It's a disagreement that can occur among providers about where the pain is potentially coming from, and whether a damaged disc can be a source of that associated back pain.

If you've been living with chronic back pain that no one can explain, ask directly whether discogenic pain has been considered in your case, and what it would take to confirm or rule it out. If the answer that you keep hearing is that your pain is a mystery, that's a reason to get a second opinion from a spine specialist who may be able to look at your situation from a different perspective.

This content is for educational and informational purposes only and is not intended as medical advice.

09/12/2026

When you're facing spine surgery, it's easy for all of your attention to land on the procedure itself. What matters just as much is the outcome: what the surgery is meant to give you back, and how likely you are to be living the life you want on the other side of it.

Dr. Ahilan Sivaganesan, a fellowship-trained neurosurgeon, describes how he'd approach the conversation if a family member of his were facing spinal fusion. He wouldn't just ask whether the surgery works in general. He'd ask for her odds on specific outcomes, with specific timeframes, because those numbers are what determine what her life looks like down the road after recovery.

Which outcomes matter most is different for everyone. Being back at work by a certain date, avoiding a second operation, being able to lift your kid or get back on the bike. When your surgeon knows what you're aiming for, the conversation becomes focused on which option gets you closest to the life you want.

Here is a list of good questions to bring up with your surgeon if you’re dealing with chronic leg and/or back pain and deciding which type of spine surgery is best for you:
How likely am I to be back at work, and by when?

What are the chances I need another surgery down the road?
What's the chance I need rehab afterward, and for how long?
What does recovery realistically look like at three months, six months, a year?
For someone in my situation, what are my odds of getting back to the things I care about most?

Having a successful outcome is set up by having the correct expectations and what post-surgery is going to look like. The better prepared you can be going into surgery, the better chances of having the outcome you are striving for.

This content is for educational and informational purposes only and is not intended as medical advice.

09/09/2026

Terms like bulging disc and degenerative disc disease can be scary when you find them on your MRI report. Dr. John Peloza, an orthopedic spine surgeon, breaks down what these terms really mean.

What your disc looks like on an MRI and the symptoms you are feeling from your disc are two separate questions, and only one of them explains why you're in pain. This is true for both the terms bulging disc and degenerative disc disease, which can sounds like a verdict but simply describe an imaging finding.

"You have a bulging disc" is a description of an image. What you care about is if that description is the actual cause of your pain or not. Having that answer is what a treatment plan gets built from.

If you’re a patient who has found bulging disc or degenerative disc disease on your MRI report, and you’re not experiencing any pain or symptoms, you likely don’t need treatment at this time. Many people in the general population will have asymptomatic findings that may never require treatment or surgery. However, if you are experiencing chronic leg and/or back pain and have associated findings on your imaging, it’s important to speak with a specialist to discuss possible treatment or surgical options for the symptoms you’re experiencing based on the severity and duration of your symptoms.

This content is for educational and informational purposes only and is not intended as medical advice.

09/07/2026

When you're dealing with chronic neck or back pain and you've finally found an option that fits your situation, hearing that your insurance won't authorize it can be extremely frustrating. The decision stops being about your health and starts being about your coverage. For patients looking at motion-preserving alternatives to spinal fusion, that scenario unfortunately isn’t uncommon.

Dr. Jason Cuéllar, an orthopedic spine surgeon, deals with this insurance situation regularly. He describes consistently fighting for authorization for lumbar disc replacements, often for patients he believes would do well with the procedure. In his experience, some payers won't authorize a disc replacement past age 60, which leaves people who still have many active years remaining choosing between a fusion or nothing at all. Lumbar ADR is one example, but patients run into versions of this across many surgical treatment options.

What gets lost in a denial is that insurance authorization and best available treatment are two different things. A denial tells you what a payer is willing to fund under their criteria. A denial does not tell you what would work best for your spine health, and the two outcomes are not always the same.

That delineation is important because a denial is not always the end of the road. In some instances, denials can be overturned and surgeons and the clinic staff may be able to help you through the appeal process, if it’s right for your circumstance.

None of that guarantees a different answer. But knowing what was denied, and why, puts you in a much better position to figure out your best next steps for care.

This content is for educational and informational purposes only and is not intended as medical advice.

09/05/2026

Have you been told to put off spine surgery for as long as you possibly can? A lot of patients hear that, sometimes even from spine surgeons, and it isn't always the right advice.

Dr. Jonathan Stieber, an orthopedic spine surgeon, is careful about who that applies to. If you can manage with over-the-counter anti-inflammatories and stretching, and your back pain only flares up once or twice a year, he'd tell you to keep managing it.

Where he pushes back on patients is when waiting becomes the whole plan. He describes patients living at a four, five, or six out of ten, and dealing with chronic leg and/or back pain every day. Waking up not knowing which kind of day it's going to be, and quietly building their life around the pain, which obligations to accept, and which activities you decide you can’t manage in a day.

"Wait as long as you can" sounds cautious, but waiting has a cost of its own, and it gets paid in years of your life you don't get back. Dr. Stieber's experience is that patients in that position tend to do well with treatment. You don't have to white-knuckle your way through years of pain to earn the right to feel better.

This content is for educational and informational purposes only and is not intended as medical advice.

09/02/2026

There are more muscles that support your spine than just the ones in your back. They're in your hips, your glutes, and your legs, which means taking care of your spine involves a lot more than just your back.

Dr. John Peloza, an orthopedic spine surgeon, describes it as a system where each piece is doing a specific job. Your glutes are the primary extensors of your lower spine, working through the fascia to hold you upright and drive that movement. The tensity of your hip flexors can influence the curve in your low back, therefore affecting the sagittal balance of your spine.

And your daily activities play a role as well. Sitting for the majority of the day can keep your hip flexors short and tight while your glutes stay quiet and underused. Over time, the structures your spine relies on can get weaker and less mobile if you aren’t properly using them.

Knowing how all these muscles work together is important when looking at your spine health. Strengthening your back isn't only about your back; it's about the hips, glutes, legs, and other supporting structures holding it in position. Next time you’re going to the gym to strengthen your back, remember that there are other muscle groups that play an important supporting role in your overall back functionality.

This content is for educational and informational purposes only and is not intended as medical advice.

08/31/2026

Agreeing to neck surgery is a big enough decision on its own. It gets harder when you aren't entirely sure which procedure you're being offered and what the long term outcomes look like for that procedure down the road. Understanding exactly what's on the table is one of the most important things you can do before you commit.

Spine care hasn't traditionally worked the same way as the other major joints in the body. When a hip or a knee wears out, the usual answer is to replace the joint. In the spine, the standard of care has most often been a spinal fusion, however, newer technologies are allowing more and more patients access to motion-preserving procedures. So when you're talking to a surgeon about spine surgery, it’s important to know which options are being offered to you. It’s easy to hear something like “your disc is being removed” and assume that means a disc replacement, but your surgeon is really offering a spinal fusion.

That's why Dr. Ahilan Sivaganesan, a fellowship-trained neurosurgeon, suggests you ask your surgeon directly which procedure they're offering. Is this a fusion or a motion-preserving procedure?

As Dr. Sivaganesan explains, a fusion and a motion-preserving procedure can feel similar in the first few weeks, but the longer-term picture, your recovery and the odds of a second surgery later, can differ. Knowing which one you're getting, and why, is worth the conversation before you commit to any specific surgery.

This content is for educational and informational purposes only and is not intended as medical advice.

08/29/2026

If you've been told you need a spinal fusion for your leg and/or back pain, it's reasonable to want to know whether that's really your only option. And plenty of people put off seeing a surgeon at all because they picture the worst version of spine surgery, a big procedure with tons of fusion hardware in their back, and months and months of recovery.

Dr. Jonathan Stieber, an orthopedic spine surgeon, says that doesn’t have to be the case for every patient. When a nerve is pinched, the goal is to take the pressure off it and relieve the pain. Getting to that nerve used to mean a bigger incision and removing more bone and ligament on the way in. Take enough of those supporting structures out and the spine needs a fusion to stay stable afterward.

But today, that isn’t always the case. There are now minimally invasive techniques that work through a small tube, or an endoscope or microscope, where surgeons can reach nerves without disrupting as much of the supporting structures around it. Dr. Stieber describes cases where historically fusion was the only option available that he now handles in 20 or 30 minutes through a small incision, about the size of a dime, sending patients home the same day.

What's possible depends on your anatomy and what's causing your symptoms, which means it’s not right for every patient, but expands options for patients with the right indications. If a fusion has been recommended, ask what makes it necessary for you, and whether a less invasive, non-instrumented procedure could treat the same problem.

This content is for educational and informational purposes only and is not intended as medical advice.

08/26/2026

If your back and/or leg pain eases the moment you sit down, or you find yourself leaning onto the shopping cart subconsciously to help alleviate your pain, that pattern may be telling you something.

Spinal stenosis, which simply means narrowing, is a condition where the canal your nerves run through gets tighter over time. When you move, that space can closes down and may cause pain, numbness, or weakness in your legs or back. Depending on the type of stenosis, bending forward can help open it back up, and for some people that’s why sitting or leaning tends to help alleviate the pain.

Dr. John Peloza, an orthopedic spine surgeon at Peloza Spine, walks through why the location of that narrowing matters. Stenosis can be defined as central canal, lateral recess, or foraminal. When located in the central canal, it’s narrowed where your spinal cord runs, or out in the foramen, where the nerve roots exit the spine. Each type of stenosis produces a different pattern of symptoms.

That distinction is the reason two people can both have back and leg pain and need completely different treatment. Dr. Peloza believes knowing exactly where the narrowing is happening, and what is specifically causing your symptoms, is what helps determines the best way to treat it.

So if you've been dealing with off and on leg and back pain that changes with positioning, it’s worthwhile to talk with your surgeon about what may be causing the pain and if spinal stenosis may be the source.

This content is for educational and informational purposes only and is not intended as medical advice.

08/24/2026

Getting answers for chronic back or leg pain can sometimes feel like a maze jumping around from provider to provider. Your primary care doctor sends you to pain management. Pain management sends you to physical therapy. Physical therapy sends you to a spine specialist. Then it's imaging, X-rays, MRIs, CT scans. And then the specialist ends up sending you back. Months go by and you're still in the same pain you started with.

What wears on you isn't just the waiting. It's retelling your whole story at every new appointment, getting your hopes up for each one, and leaving with another referral instead of an answer. At some point you start wondering whether anyone is actually looking at the whole picture or you're the only one keeping track.

Dr. Ahilan Sivaganesan, a fellowship-trained neurosurgeon, has seen this story play out over and over. He wanted to know why and how it was occurring so he had medical students trace one patient's real path through that system and map every visit, scan, and referral. It took that patient two and a half years to get answers, and the map of it literally looks like a hornets nest. And this experience isn’t uncommon, Dr. Sivaganesan calls it one of the biggest problems in healthcare.

It's worth saying that this isn't happening because you picked the wrong doctors or didn't push hard enough. Each referral usually makes sense on its own. The gap is that no one can see the whole picture, and right now that job often falls to the patient by default.

A few things that can help: keep your own running record of what's been tried, what changed, and what each scan showed, so you're not rebuilding your history from memory every time. Ask directly who is coordinating your care from start to finish. And when you do get in front of a specialist, ask what they are basing their decisions on to determine how to move forward, so you leave knowing the next step instead of just the next appointment.

This content is for educational and informational purposes only and is not intended as medical advice.

Address

Austin, TX
37402

Telephone

+19728024019

Website

,

Alerts

Be the first to know and let us send you an email when The Spine Pod posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Category