The Spine Pod

The Spine Pod Conversations about Motion Surgery
New episodes every other Wednesday

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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.

08/22/2026

You had a cervical fusion, and things got better for a while. Then the neck pain, arm pain, numbness, maybe even the headaches started creeping back. And for a lot of people who've been through it, the idea of going through another surgery is the last thing they want.

Dr. Scott Hodges, an orthopedic spine surgeon at Spine Motion Specialists, explains what may be causing the return of symptoms. After a cervical fusion, the level(s) adjacent to it can wear down over time. It's called adjacent segment degeneration, which can cause impingement on nearby nerves, possibly bringing back neck and/or arm pain.

If that's where you are, there may be other options available than simply another spinal fusion. Dr. Hodges explains that a cervical disc replacement can be placed above or below the existing fusion, instead of fusing that level too, for correctly indicated patients. It's an approach surgeons call a hybrid procedure. This is considered an off-label use of the device, but many surgeons utilize this to offer patients an alternative instead of another fusion.

If you’ve already had a neck surgery and are dealing with recurring pain, numbness or weakness, it may be worth a discussion with your provider.

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

08/17/2026

When a level of the spine is fused, the motion it used to handle doesn't disappear. It gets distributed to the motion segments above and below, which now do more work than they were built for. Over time that extra load can wear down discs and facets faster. It's one of the reasons people may end up needing additional surgery down the road.

Dr. John Peloza, an orthopedic spine surgeon at Peloza Spine, explains how this occurs. Fuse one level, and when the level next to it wears down, that needs surgery as well, and the cycle continues. This is how you end up in a spinal fusion cascade. This is one reason motion-preserving options matter so much. The goal isn't exclusively to fix the level causing pain today. It's to hopefully avoid turning one treated level into several surgeries.

If you’re dealing with chronic leg and/or back pain and considering spine surgery, it's worth asking whether a motion-preserving option is available to you from the start, and if fusion is the recommendation, why that’s the case. If you've already had a spine procedure and you're facing a second surgery, the question becomes whether that next level could be treated in a way that preserves mobility and function.

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

08/15/2026

Seeing "disc herniation" on an MRI report doesn’t mean you’re destined for surgery. The good news for most people, that isn’t the case.

Dr. Scott Hodges, an orthopedic spine surgeon at Spine Motion Specialists, shared with us that many people with a disc herniation will not require surgery. He also points out that around 80% of the population will deal with some form of back pain during their life, so a finding like a disc herniation or disc degeneration is far more common than it seems.

There are some symptoms that he says you shouldn’t wait on. If you have significant weakness in an arm or a leg, that’s worth getting an evaluation right away. Pain and/or numbness that aren't progressing don’t always require immediate treatment, but the severity and duration of your symptoms should be taken into consideration.

So if you just got imaging done for your neck or back and it shows a disc herniation, it doesn’t mean you’re destined for the operating room. He promotes giving conservative care a chance first, and if your symptoms aren’t improving it might be time to seek an opinion from your care provider.

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

08/12/2026

History hasn’t always been kind to innovators. Every industry has a moment where the status quo gets questioned, and often the person doing the questioning and pushing for progress takes the first hit.

Dr. John Peloza, an orthopedic spine surgeon at Peloza Spine, tells the story of Galileo, who fell victim to this exact circumstance. In the 1600s, Galileo was the first to argue that the Earth wasn't the center of everything, that the sun was, and the planets orbited around it. That idea directly contradicted what the Church taught at the time. Because of that, he was charged with heresy and spent the rest of his life under house arrest. As Dr. Peloza puts it, the innovator is often the one with the arrows in their back.

The spine industry has faced similar hurdles over time. Spinal fusion has been the standard of care for decades, however, newer motion-preserving technologies have opened doors for alternative treatment options for both surgeons and patients. Although everyone is in the pursuit of better spine care, not everyone agrees on what better care looks like.

Through trial, error, and data, standards are meant to be tested, and the adoption of new technologies, across any industry, almost always face challenges. Every advancement in healthcare that we have today exists because someone was willing to challenge the status quo and demand better.

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

08/10/2026

Living with chronic pain can be all-consuming. It affects every part of your life: how you sleep, move, work, show up for friends and family, even how you think.

Dealing with long-term chronic pain can feel isolating. You can describe it, and they'll nod in agreement, but unless they've felt it themselves, they truly can’t get it.

Bonnie, a Realtor and social media manager, experienced this exact situation. Chronic pain in her arm and shoulder led her to seek specialists’ opinions in those areas, when in reality it ended up being a neck issue. Trying to manage conservative care, pain levels, doctor's appointments and uncertainty along with daily activities took over her life as she searched for answers for her constant pain. She didn't know what chronic pain really does to a person, or how much it changes the way you move through your day, until she was living it.

If you've been there, you're not alone.

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