Alex P. Michael, MD, FACS

02/07/2026

I recently had the pleasure of sitting down with Drs. Dustin Anderson and Preston Le to discuss their outstanding review, **"Hip-Spine Syndrome: Diagnostic and Rehabilitation Considerations for Clinicians,"** featured in the latest issue of *SpineLine*.

We dive into the challenges of diagnosing hip-spine syndrome, distinguishing hip from lumbar pathology, the role of spinopelvic biomechanics, and practical rehabilitation strategies that can help improve patient outcomes.

Whether you care for patients with low back pain, hip pain, or both, I think you'll find this to be a valuable discussion.

Watch the conversation here: https://www.youtube.com/watch?v=YdnZIqKXqYk

Authors Preston Le, MD, and Dustin Anderson, MD, discuss their rece...

22/06/2026

Caffeine and the Illusion of Sleep

The biggest caffeine mistake is judging it only by whether you can fall asleep.
Falling asleep is not the same as getting restorative sleep.
Research has shown that caffeine taken even six hours before bed can disrupt sleep quality, reduce deep sleep, and fragment the structure of the night — even when people do not feel like they had trouble falling asleep.
That matters because sleep architecture is where the brain does the work that actually restores performance: glymphatic clearance, memory consolidation, emotional recalibration, and prefrontal cortex recovery.
So yes, you may be able to drink coffee at 4 p.m. and still fall asleep.
But the better question is whether your brain gets fully repaired that night.
For high performers, caffeine timing is not a wellness detail. It is next-day brain function.

15/06/2026

Caffeine Doesn't Give You Energy

Caffeine does not give you energy.
It blocks the signal that tells your brain you are tired.
That signal is adenosine. As the day goes on, adenosine builds and acts like a brake on arousal, motivation, and effort. Caffeine blocks that brake. In the striatum, this matters because adenosine interacts closely with dopamine signaling, which helps explain why coffee does more than make you feel awake.
It can make effort feel more available.
The inbox feels less irritating. The chart feels less impossible. The manuscript, deposition, workout, or case review carries less resistance. That is useful — but it is also why caffeine becomes psychologically sticky. The brain starts pairing caffeine not just with alertness, but with action initiation.
Over time, the absence of caffeine can feel like low drive.
That does not mean caffeine is bad. It means it is powerful. Use it like a tool, not a personality.

08/06/2026

Automate the Small Stuff to Protect the Big Stuff

Obama wore the same style of suit to remove one more meaningless choice from the day.
Zuckerberg did the same thing with the gray shirt.
That may sound trivial, but it is the right instinct.
The prefrontal cortex is the brain’s executive system. It handles judgment, restraint, planning, and difficult conversations. The anterior cingulate cortex helps calculate effort: how hard something feels, whether it is worth doing, and whether the brain should keep pushing or take the easier path.
By the end of a long day, too many small decisions make real decisions feel heavier than they should.
That is why decision automation matters.
Move the low-stakes choices into habit.
Protect the prefrontal cortex.
Lower the effort signal.
Save the brain for the decisions that count.

11/05/2026

The brain cleans itself while You sleep. Here's what most people don't know:

Your brain has its own waste disposal system. It's called the glymphatic system — discovered just over a decade ago — and it runs almost exclusively while you're asleep.

During deep, slow-wave sleep, your glial cells shrink by up to 60%, opening channels that flood the brain with cerebrospinal fluid. That fluid sweeps out the metabolic byproducts of a day's worth of thinking — including beta-amyloid and tau, the same proteins implicated in Alzheimer's disease.

Skip sleep, and the trash piles up. Literally.

A few practical points:

Deep sleep is the work shift. Not light sleep. Not "lying in bed." The clearance happens in the deepest stages, which front-load the first half of the night.

Alcohol and late screen time blunt deep sleep architecture — meaning the cleanup crew clocks out early.

Sleeping on your side may enhance clearance compared to back or stomach (animal data, but consistent).

Your cognition tomorrow is built on the cleaning your brain did last night. Protect the shift.

01/04/2026

01/04/2026

Thank you to the St. Louis Science Center and Medtronic for such a wonderful event. It was incredibly rewarding to give the public hands-on access to real OR equipment and a chance to experience what it’s like to be a neurosurgeon.

12/03/2026

I’m excited to begin a new chapter with the Department of Neurosurgery at Washington University in St. Louis and honored to join such a distinguished and nationally recognized team.