The Spine Pod

There's a specific kind of exhaustion that comes with neck, leg and/or back pain no one can explain. You feel it every day, but scans come back as "not bad enough," and you're stuck in between too much pain to ignore and a major reconstructive surgery.

If that's where you are, Dr. Ahilan Sivaganesan's message is worth hearing. A scan that looks “normal” doesn't mean your pain isn't real, and it doesn't mean you're out of options. And some causes of this kind of pain, like an annular tear, are easy to miss on standard imaging and more treatable than people expect.

That in-between, where the pain is real but no one can name the cause, often comes with a quiet sense that your only choices are to live with it or brace for a major operation. That doesn’t have to be the case. So if you're not sure what your next step is, it's worth asking a spine specialist what could really be driving your pain and what smaller, less-invasive options might exist. Sometimes the answer is one that requires a closer look.

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

Orthopedic surgeons used to routinely fuse knees and hips, and today we couldn't even imagine that being a standard of care. So why is it still common to fuse the spine?

Dr. Ahilan Sivaganesan explains why spine has fallen behind other joints in the body. When you fuse a knee or a hip, the impact is clear and you can see it in how the person moves almost right away. The spine doesn't always show itself the same way. When fusing the spine, although patients can experience pain and/or symptom relief, there can be long-term consequences to patients down the road that aren’t immediately visible.

That slower, quieter timeline is a big part of why spinal fusion remains the standard of care. The benefits can show up immediately, but the cost, if it comes, is easy to underestimate because it comes later. That makes the decision between treatment options that much more important, to make sure you’re weighing all the risks and benefits to help find the procedure that best fits your specific condition and situation.

If you’re someone that is dealing with neck, leg, and/or back pain and facing possible spine surgery, these are good questions to ask: how: how might this implant affect adjacent levels over time, what are the long-term outcomes for this type of surgery, and is motion preservation an option for someone in my situation? Every patient’s situation and condition is different, but it’s important to know your options before deciding on which treatment is best for you.

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

Cervical disc replacement (CDA) isn’t one-size-fits-all. If you’re considering cervical disc replacement for your neck and/or arm pain, there are many important factors to consider when deciding which surgeon and type of disc gets used for your specific condition.

As an expert in disc replacement, Dr. Jason Cuéllar has worked with just about every cervical implant available, and that hands-on experience taught him something that matters a lot for patients. The right disc depends on your specific condition, your anatomy, and the goals you have for life after surgery. A surgeon with experience with multiple cervical discs can weigh all these factors and match the correct treatment to the individual, which is what personalized care really looks like in practice.

And that's what you're hoping for when considering a surgery of any kind, the understanding that your treatment was built around you. If you've ever felt rushed or unheard when trying to seek treatment, it helps to know that kind of care is out there.

So as you weigh your options, that's the thing worth looking for: a surgeon whose experience runs deep enough to consider everything on the table to tailor the approach to your personal situation and get you back to the life you deserve.

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

Not all spine surgeries are built the same. When dealing with neck, leg and/or back pain and looking at spine surgery, the training and expertise of your spine surgeon matters, and that's especially true when deciding between a fusion and a motion preserving procedure.

Dr. Ahilan Sivaganesan explains the biomechanical differences that surgeons need to take into account when utilizing motion preserving implants. When the goal is to keep your spine moving, the placement of the implant has to account for things like balance and center of rotation, because it's working with your body's natural motion rather than stopping it. Those considerations are exactly where a surgeon's experience pays off.

So whatever care you're considering, it's worth seeking out a provider who genuinely specializes in it. When it comes to surgery, you want the person who does it day in and day out.

And the simplest way to find that out is to ask. Asking a surgeon how often they perform a specific procedure, if it’s a main focus of their practice, and/or what their outcomes tend to look like are great starting points for better understanding the treatments you’re considering.

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

If you're dealing with leg and/or back pain and facing spine surgery, it can be difficult to parse through clinical and outcomes data to know if a treatment option is worth exploring.

Dr. Jason Cuéllar walks us through one motion preserving surgical option and the data that it has accrued over the years. Disc replacement has been around in the US for more than 20 years, with many clinical studies on both lumbar and cervical disc replacement analyzing long-term patient outcomes. By any reasonable measure, that's not an experimental procedure anymore.

If you're facing spine surgery and looking for a motion preserving option, don't take "experimental" as the final word. Seek out a spine surgeon who specializes in motion preservation and have them walk you through the research, the outcomes, and whether you're a candidate.

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

You did the responsible thing and gathered multiple opinions, so why did every surgeon tell you something different? You've lived with the neck, back, or leg pain long enough that surgery is on the table, and now you're sitting with a stack of conflicting recommendations, thinking they can't all be right. It's exhausting in a way that's hard to explain to anyone who hasn't been through it.

That's not a failure on your part. It's one of the harder realities of navigating spine care, where the same imaging and the same symptoms can genuinely lead different surgeons to different recommendations depending on their training, their experience, and the philosophy driving their practice.

Dr. Ahilan Sivaganesan offers a way to cut through the noise of conflicting surgical recommendations and find a surgeon whose approach is actually aligned with your best outcome. Beyond credentials or technique, the question worth bringing into every consultation is about where a surgeon starts. Is this a surgeon asking how to get you a durable result without a fusion if at all possible? Or someone working backward from fusion as the assumed answer before they've fully considered the alternatives?

That distinction, he says, is the North Star. If you've been through the opinion carousel and still don't know who to trust with your spine, that's the filter worth applying.

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

How do you know if you got a total disc replacement or a spinal fusion?

"We replaced your disc" and "we gave you an artificial disc replacement" are not the same thing. Some patients leave the operating room thinking they got a disc replacement and find out after the fact that they got a spinal fusion. Not because anyone misled them, but because the language around these procedures is close enough to create real confusion.

Dr. Jason Cuellar walks through why this confusion happens and what it means for patients who are going into a disc replacement conversation without knowing exactly what to ask.

In a fusion, the disc is removed and replaced with a cage, essentially a rigid spacer, packed with bone graft material to encourage the two vertebrae to grow together and permanently lock that segment in place. In a true artificial disc replacement, the disc is removed and replaced with a device that has moving parts, designed to mimic the natural movement of a healthy disc and keep that segment of your spine mobile. One option locks. One option moves.

It's an easy thing to misunderstand, and it isn't always explained clearly up front. So Dr. Cuéllar's advice is simple: ask your surgeon what they plan to replace the disc with, and ask them to show you the actual device going into your spine. If it's a motion-sparing artificial disc, they'll be able to show you exactly that.

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

If you're in the process of finding a spine surgeon for disc replacement, one thing worth knowing before you make that call is that this procedure rewards specialization in a way that not every spine surgery does.

Dr. Ahilan Sivaganesan explains why disc replacement is a procedure where volume and specialization carry real weight. It's a more technically demanding surgery than spinal fusion, with more variables that need to be accounted for to get a good outcome. The difference between a practice that does this every day and one that does it occasionally isn't just about the surgeon. It's the whole team, the familiarity with the details, the institutional knowledge that builds up when a procedure is part of your daily rhythm rather than an occasional one.

That's not a reason to feel anxious about your options. It's a reason to feel empowered to ask better questions when you're evaluating surgeons. How many of these do you do? What does your team look like? Is this a significant part of your practice?

You're allowed to ask those questions. The right surgeon will welcome them.

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

If you're trying to decide between cervical disc replacement (CDA) and cervical fusion (ACDF), the short-term prognosis doesn't always tell you everything you need to know. Most patients do well in the first couple of years regardless of which procedure they have. The part that matters more are the long-term implications of the type of treatment you choose.

Dr. Jason Cuellar gets into what the long-term data shows when you put these two procedures side by side, and the gap between them becomes more meaningful the further out you look. The early recovery window can feel similar. It's the years after that tell a more complete story about mobility, function, and patient satisfaction.

One area of significance where CDA outperforms ACDF is in adjacent segment disease in the years following your initial surgery. Based off published data, ACDF can come with an up to 3-5x greater risk of re-operation due to adjacent segment disease postoperatively. That isn’t a small difference, that’s an increased risk when comparing the two procedures.

If you're in the comparing stage right now, Dr. Cuellar shares some extremely valuable outcomes data that may help you inform your decision. CDA might not be an option for every patient, but it’s worth the discussion with your surgeon to see if a motion preserving option is available to you.

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

Disc herniations are not one size fits all. You might be experiencing back pain, sciatica, muscle weakness or numbness, and each of these could point to a disc herniation. Where your disc herniation is located dictates the type and extent of symptoms you may be experiencing and it can be disorienting when your symptoms don't seem to follow a pattern you can make sense of.

Dr. Sivaganesan shares the breadth of symptoms patients might experience when dealing with a disc herniation. As he notes, some herniations are worth watching and managing conservatively. Others that cause a neurologic deficit may require more immediate treatment. Understanding which situation you're in is one of the most useful things you can get out of an early appointment with a spine surgeon before you've committed to any path forward.

If your symptoms feel hard to explain and you’re looking for answers to your leg and/or back pain, it might be time to meet with a spine surgeon to discuss your possible treatment options.

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