December 8, 2025 • 45 mins
Dr. Jazini is a board-certified spine surgeon at VSI, internationally recognized for his expertise in motion-preserving spine surgery, minimally invasive techniques, and surgical innovation utilizing the latest technology. With extensive training and over ten years of clinical experience in disc replacement, Dr. Jazini continues to lead the field in redefining standards of care.
Dr. Jazini’s Links:
IG: https://www.instagram.com/dr_jazini/
LinkedIn: https://www.linkedin.com/in/ehsan-jazini-spinesurgeon/
Learn More about Dr. Darian:
Website: https://doctordarianparker.com/
LinkedIn: https://www.linkedin.com/in/darianparker/
Dr. Darian’s Partnerships:
Health Loft
Nutrition is an important piece in reaching your health and well being goals. That is why I have partnered with Health Loft. Health Loft connects you with a registered dietitian for personalized nutrition. Sessions are remote, covered by insurance for many people, and your first session is free. Health Loft will check your insurance benefits for you to determine if you would have to pay anything for future sessions. Click here to book your first free session: https://healthloftco.com/partners/parkerpt/
CONNEQT HEALTH
CONNEQT Health is transforming health monitoring by making advanced arterial health insights accessible to everyone through the CONNEQT Pulse. This device empowers individuals to measure and understand key indicators of their vascular health through the first and only FDA-cleared at-home device that goes far beyond the traditional blood pressure cuff. Please use the link below to purchase a CONNEQT Pulse. You can receive 10 percent off the purchase of the unit by using the code: Parker10.
Relax the Back
Relax The Back® embraces a holistic approach for a healthier lifestyle grounded in 40 years of proven expertise. Live wellness is our commitment to helping you transform your routine, your space, and your life, with solutions that elevate your physical and mental well-being. Use this link: Relax the Back level up your well being.
Blumaka
Run better. Move smarter. Save 20%.
Blumaka insoles are built for performance and sustainability, offering elite-level cushioning, grip, and durability with up to 85% recycled foam. Use code FSF20 for 20% off: https://blumakastore.myshopify.com/discount/FSF20
Stick Mobility
Get your flexibility back and prevent injuries with Stick Mobility. Training Sticks improve range of motion, muscle activation, coordination, and body awareness to build a strong foundation for better movement. Go to this Link or copy to your browser https://stickmobility.com/darian-parker and use the discount code: 1CEC828F154 to get 10% off of your purchase.
Hyperice
Grab your Hyperice gear and get 10% off using my affiliate link: https://tidd.ly/4noSOfW
From percussion to compression, elevate your recovery like a pro.Discount applies at checkout.
Time Stamps:
00:00 Introduction and Guest Welcome
00:49 Basics of Spine Structure and Function
02:07 Understanding Spine H
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
All right, well, we have an awesome episode here today and
I've been looking for a while for someone to talk about spine
health with all of the differentaudiences that I work with, from
students to colleagues to clients.
And so I'm pretty pumped that Doctor Gesini is here to talk
about spine health. He's been very busy coming from
(00:22):
patients, surgery to all these things.
Thank you for giving me some of your very valuable time to
discuss this, Doctor Jezzini. You're welcome.
I'm very happy to be here and and to speak to you.
This is very obviously a very important topic.
Obviously as a spine surgeon, this is what I do each and every
day. And so I'm happy to share my
(00:43):
sort of thoughts and and expertise on this topic with
with you and your audience. Excellent.
No, it's great. And and we're going to focus
this today really on starting with the the basics as I talked
to Doctor Giazzini and Discoverycall, I do with all of the
guests here, love to get to knowthe guests, but we really want
to not jump too far ahead too quickly, but create an
(01:07):
operational definition of what we're actually talking about
with the spine. So Doctor Giazzini is going to
talk a little bit first about the basics of the spine
structure, function, Physiology,and then we're going to move on
from there. Yeah, I mean, I think a good way
to sort of sum up what we're going to talk about today is
that this is really spine healthone-on-one from prevention all
(01:28):
the way to surgery. I'll start with just introducing
myself to your audience. And Dr. Bazini, I'm a spine
surgeon here in Northern Virginia right by DC at Virginia
Spine Institute, also called BSI, which is a practice has
been around for 30 years. What's really unique about
myself and this practice is thatwe are all inclusive Spine
(01:48):
Institute. That means we have both
surgeons, but physiatrist, neurologist, the physician
assistants, physical therapists all working together really to
help with spine healthcare. Most of what we do, even though
I'm a surgeon is actually non operative care all the way from
physical therapy to regenerativetreatments to surgery, right?
So my interest today is to sort of lay out what is spine?
(02:13):
What's the function and structure like as you said for
spine. And you know, most of us don't
think about a spine until it hurts, right?
So what we want to do is to talkabout what it actually does, why
it starts to break down in some people, what we you need to do
to protect it, right? And what I do as a spine surgeon
(02:34):
when things don't go as well, right?
And so that's so the goal here. So talking about sort of the
structure and function of spine,it's best to sort of first
build, I would say a mental model for the audience, right?
And the best way to understand it is, well, what, what is it
doing, right? It's a spinal column, right?
(02:56):
And So what that means that it's, it's, it's the foundation
for your head and your torso, right?
It allows us to be upright animals, right?
That's how we can stand, right? That's how we can function.
The other aspect of it is the spine.
As most people know, it's not like nice and straight like
(03:17):
this, right? It has curvatures, right?
That curvature is built in that way in order to provide a spring
like effect. It's a shock absorber.
I'll talk about the entire structure of the spine.
Then within those columns, right, you have the vertebral
bodies which are basically stacked one-on-one top of the
other. You have the things that are
(03:39):
called discs. Those are the cushions that also
provide that cushioning, right? The other function of the spine
is that it's provides a tunnel, a Bony tunnel that protects the
very vital thing called the spinal cord that sends the
information from the brain to our extremities and to the OR
(04:02):
other organs, right? And so it's like that inner cage
that you can see pretty much in a lot of the other animals as
well that supports and protects that.
The last thing that in terms of structural standpoint is the
functionality piece of it. It allows us to move.
It's not a rigid piece that justdoesn't move, right?
(04:25):
Each of those segments move on top of each other in a very
rhythmic but also systematic way, right?
That allows you to bend, just twist to look right?
So we can then break it down into the individual main parts
of the spinal anatomy, you know,and these are terms that I'm
(04:47):
sure a lot of audience members have heard, like what's a
vertebral body, right? Really what it is, is those
building blocks of bone that arestacked between those cushions
called the disc that we just talked about.
Then you have the fasted joints,which are the hinges.
They're the small guide rails inthe back of the spine that
(05:07):
allows that motion, and those joints in different parts of the
spine allow different degrees ofmotion, which is important as
well. Then you have the ligaments and
muscles, which are like the guy wires and active stabilizers.
And finally, you got the nerves,those things that send the
either the power to our muscles or the sensation from the legs
(05:32):
or the hands, fingers back to the brain, right?
So you know, you want to think of your spine like a flexible
skyscraper, right? The bones are the floors, the
disc of the cushioning between them, the joints and ligaments
are the connections and the muscles are the constant act of
support, keeping it upright and moving smoothly, right?
I just want everyone to sort of get the mental picture as we go
(05:56):
down to the next topic, which is, well, why does it break down
right? And you can really split this
into two different aspects, right?
You have the normal wear and tear and then you have southern
events like a traumatic event, right?
The reason I got into spine is from a that from an event like
(06:17):
that. My brother got into a really bad
car accident as a family and he had multi Poly trauma, you know,
brain injury, spine injury and really seeing doctors get him
back to where he is now, it really inspired me to do the
same, right? That was a calling for me as a
spine surgeon. But for most people it's not
(06:37):
traumatic. It's really normal wear and tear
where it gets a little bit more complicated as genetics, right?
Ultimately we're all we are to some degree.
Our genetics is defined us as people, right?
And so where that becomes a hugefactor is in some people that
normal wear and tear that happens starts at an earlier age
(07:00):
versus you have a more of a propensity to have disk issues
at a younger age. So then as that normal wear and
tear happens, you know, they had, they start having problems
in their 20s and 30s versus let's say in their 40s and 50s.
But that wear and tear happens no matter what.
It's like, you know, you drive acar, the tires eventually will
wear out and the more you drive that car, you're going to wear
(07:22):
it out faster. You need to change the tires
now. They're different brands of
tires. So some people are with the, you
know, the top notch tire and so you can last a little bit
longer, but at the end of the day, it's going to wear out if
you drive it long enough, right?Do we know like the difference
like percentage wise genetics, terms of populate like I don't
(07:44):
want to say this like how big ofa genetic contribution is there
to the wear and tear between individuals?
It's not simply because there's an interplay where, you know,
the, I would say if you say, heyman, give me a number, I would
say it's probably 7030 genetics to wear and tear.
But it's a little bit more complicated than that because
(08:06):
there's an interplay between your activity and your genetics.
And what I mean by that is the same person who has the P
disposition, they will actually that genetic aspect will be
accentuated with with poor mechanics or let's you know what
I mean? Like let's say think about like
a football player was a linebacker, right?
(08:29):
Those are guys are taking a beating to their spine, right?
The guy with really poor genetics for their disc will
have way more of acceleration than the person who doesn't.
So it's probably more like 9010 in that scenario, right?
So that that ratio will change depending on your habits,
lifestyle choice choices and howmuch, you know, load you're
(08:51):
putting on your spine. So but genetics is a huge part
of it, OK? It doesn't mean that there's
nothing we can do about it, right?
It actually means there's, it makes even more important for
you to make those good choices and for us to guide our audience
in terms of, and what I want to do with my patients and educate
(09:12):
them because prevention is all ultimately the key, right?
So getting to the sort of nitty gritty of like a what's breaking
down, you know, we can break it down into those structures.
So the disk is soft, those cushions degenerate because they
lose water content over time. There's a process called
glycosylation where the collagenfibers in within the disk
(09:36):
itself, sugar molecules are attaching to them and it's
making them dehydrated, it's making them stiffer, which then
causes stiffness, right? The joints, those facet joints
we talked about earlier, they lose their cartilage, they lose
their fluid, they lose their lubrication, which then causes
stiffness and pain. Then you have the muscular
aspect of the of the spine that we talked about and poor
(09:59):
mechanics like a weak core or hip and you know, tight
hamstrings, prolong sitting, a forehead posture, heavy
repetitive lifting. These are where the contribution
comes from those structure. And ultimately then there's the
lifestyle factors, things that are, you know, sounds obvious,
right? Obesity, smoking, sedentary
(10:20):
lifestyle, heavy repetitive lifting, right, or poor lifting,
right? Like think of deadlifts like
I'm, I love to be fit. I you know, I did, I've done
CrossFit, I've done other works forms of workout and a lot of
those injuries happens from poorform, right?
Deadlift is actually a great exercise, but done poorly.
(10:42):
It's it's horrible for your back.
That load is going to be concentrated in, in that
especially the the lower disc that cushion in in your lower
back. So, you know, to summarize this
section, I would say most spine problems, right, aren't one huge
injury. There is slower drip of stress
over years and years, sitting a lot, not moving enough, lifting
(11:05):
or working out with poor mechanics and sort of the normal
aging of the disc and joints, right.
That that's a way to sort of summarize that, you know, that
aspect of it. Then we want to sort of get to,
well, what's the, the southern structural problems that we see,
the traumatic things that we see.
And it's not always like a high velocity injury like, you know,
(11:26):
my brother suffered from, you know, 1 terminology that a lot
of patients have heard of is like this herniation.
Well, that's really just that Jelly.
That cushion is pushing out and irritating a nerve, right?
If it hits a nerve, you'll feel it down your arm or down your
legs. If it's more central, you may
just have severe back pain that's very debilitating,
causing severe pain. You can then develop as a result
(11:50):
of that something called spinal stenosis, which is the narrowing
of those nerves, which is essentially a blood flow issue,
right? If they don't have as much room
to breathe, well, guess what? You're going to have trouble
with standing and walking because it's a perfusion
problem. It's like you're, you get chest
pain. If you're, you're not getting
enough blood supply to your own heart, right?
You get a get a heart attack. But initially when it's not as
(12:12):
bad, like you'll get some exertional chest pain, let's say
going up the stairs, then they're the same thing.
They're going to give the signalback to you to say, hey, there's
a problem by hurting when there is not enough perfusion there,
right? Then you can have instability.
Something called spondylolethesis is a Greek term
that means one vertebra, one building block is shifting in
(12:33):
front of the other one, which can cause nerve pain and pain,
just mechanical pain, right? Then going down to the more
traumatic aspect of things, right, you can have trauma or
let's say compression fracture where the bone itself actually
has failed from mechanical stress.
Now, either because the stress was was high enough to cause the
(12:55):
fracture or the bone was weak, right?
So building and maintaining a good bone density is a critical
part of a good spine health. And I encourage all my patients
to be very proactive. As a society, we're a little bit
reactive in medicine, unfortunately.
And we sort of wait until the patient's 60 years old to tell
him, wait, listen, you're, you know, the past 30 years you've
(13:16):
been losing a lot of bone density will not do something
about it where now you, you know, your options are more
limited, right? But if we can encourage patients
to do weight bearing exercises and really load their spine and
their bones and make sure that you know, if there's hormone
deficiency, vitamin deficiency, some of the identifiable causes
(13:37):
can be reversed. It's much better to do that head
on at an earlier age than to wait until you're in your 60s to
then try to medicate yourself out of that, right?
And then we don't want to forget, forget about the red
flags, right? Things like history of cancer,
unexpected weight loss, infection, fever, night pain.
(13:58):
These are things that obviously you want to see someone quickly
because those are not routine things that should be missed,
right? You want to make sure that our,
our, our, our, our audience is educated on that, right?
Before I go to the next section,I just wanted to kind of make
sure that you had no other questions.
I have tons of questions man. I just think.
(14:21):
But my goal always is I want theexperts to talk and give their
expertise and then I jump in when appropriate.
But we mentioned about spinal loading.
This is something I want to get your opinion on, your expert
opinion here. So you're talking about dead
lifting and my audience is obviously students, anatomy
students are going to be in different healthcare jobs, but
(14:44):
it's also personal trainers and different clients.
So there's a lot of opinion out there about spinal load and
compression on the spine. And actually a lot of my
colleagues who are very educatedon moving away from a lot of
heavy spinal loading with Olympic lifting bar, you know,
(15:05):
dumb barbell squats, educate us on this, on what is potentially
effective in doing this and whatcould be a tipping point for
being not effective and actuallycausing harm to the spine with
with loading the spine. I think ultimately it's it's
it's in some ways it's complex, but some in some ways simple.
(15:27):
If you cannot maintain proper form on every single Rep, then
that weight is too much. So ultimately what you need to
do is first work on your flexibility, then work on the
strength, and then build up to an appropriate level.
(15:48):
I'm not a big fan either of heavy, heavy loads.
Yeah, because life is a marathon, right?
We're not trying to do the Max load that you can do.
I mean, I don't at the end of the day, you know, one of my
mentors always says the end, theend goal should be the first
thing in mind. If you know what your end goal
(16:10):
is, then you figure out, OK, what do I need to do achieve
that, right? And so the goal here is good
health. The goal here is bone,
maintaining a bone density, maintaining your flexibility,
maintaining function. And so I'm not there working out
to impress anyone. And unfortunately what happens
(16:31):
is we are all competitive. I'm I'm super competitive as
well, right? And you're especially some of
these classes, right? You're like putting Max weight,
Max rap. And that's where we forget
people get into trouble, right? But super athletes get in
trouble because they're exhausted, they're fatigued,
(16:52):
they're trying to get to certaintarget weight and then their
form is off and it doesn't take much.
Your form is out, you have this,we just talked about this normal
wear and tear. And so it doesn't take much for
you to be over that tipping point, right?
So does it help answer that question He gets because then
(17:13):
you have to sort of watch it's very individual, right?
Some people have poor ankle motion, some people have poor
hip motion. So for me to be able to then
just guide big picture, it's impossible, right?
You know, getting a trainer, working with a trainer, really
individualizing it to each person is critical.
(17:36):
There is not a one-size-fits-allhere.
But if you have that guiding principle of maintaining
flexibility that were you neededto do that proper exercise is
key, right? And you've developed in our
practice something called like blood flow restriction, right?
You have athletes that can't, let's say, do a certain load
(18:00):
safety right now because of the injury.
Well, there's a waste. There's Cheat Sheets around
that, right? You can restrict the blood flow,
trick the body to be able to getthe same results by restricting
some of that blood flow, right? So there are other very advanced
ways that we can achieve those results, right, without causing
undue stress to the spine. And so that's the key is at the
(18:21):
end the goal is spine health or physical health in, in, in this,
in this, when it comes to this question, but how do we achieve
it without causing another problem, right?
It's actually flows really well into the next topic, which was
prevention and sort of everyday health, spine health, You know,
what do we, what can I do beforethey, someone can meet me in the
(18:43):
clinic, right? 1 one area is really sounds kind
of obvious is just regular movement.
You want, you don't want to be sedentary.
You're right, you don't want to,you don't want to sit for more
than 30 to 45 minutes. So one area where I've seen a
lot of improvement is, you know,patients, you know, a lot of
patients now have stand up desk or this desk that go up and
(19:05):
down. So they're not in an office.
You know, as a surgeon, I'm not sitting down much, right, Just
because of I'm operating, I'm going between rooms seeing
patients. But that could be a lot more
challenging for someone who sitsat a desk, right, in a cubicle
or an office, right? So I think a stand up desk, you
know, they have those walking treadmills now where you can
(19:26):
stand and actually move your legs.
Body is meant to be moving and the more stationary it is, the
more static it is. It becomes more prone to injury
because those joints become stiff, the disc becomes stiff.
They don't hydrate well when they're stationary.
And then you get up to go do something very, very medial,
(19:49):
like very ordinary. And that's how people actually
injure themselves. It's usually not, hey, I went
and did a deadlift and boom, I'minjured.
I've been over to brush my teeth.
I've been over to pick up the trash.
It's it's very mundane. I hear that all the time.
Too right? It's so, but the way you prevent
it is by moving. Keep yourself moving.
(20:11):
And not just I'm talking about exercise, I'm talking about
everyday stuff, right. Strength training is a second
topic and sort of what we were talking about before, but really
focusing on the core. So do I love weight, weight
training, Olympic weight training, yes, but not before
you've you've built a really good core.
So I got into yoga six years agoand it's tremendously helped me,
(20:39):
you know, with my some of my ownpain that I have in my to my
shoulder blades, my back from standing as a surgeon bent
forward. So working on core and doesn't
have to be yoga. It could be Pilates is critical
because the core is what is the muscles that we just talked
about the supports your spinal canal.
And, and it's like a, you know, an analogy I give my patients
(21:00):
is, you know what, you see thosemassive trees with those massive
branches, while they can't have those massive branches if they
don't have a strong trunk, right?
It has to, right? It has to be proportional.
If you have a branch that's too big relative to the trunk, it's
going to fail, right? The trunk will fail.
And the spine is the same thing,right?
(21:20):
If, if you just go in the gym and you're just doing biceps and
triceps and shoulder press and, and like press, but you haven't
worked on your core, well, guesswhat?
You're going to injure your Yeah, you can do yourself right?
And so that's really important. And core doesn't just mean the
ABS. I'm talking about the back
muscles, the glute muscles, the and the stabilizers, the
(21:43):
scapular stabilizers are really important.
And then lastly, we talked aboutthis a little bit of
flexibility, right? Hamstrings, hip flexors, A
thoracic spine mobility, becauseif your hips don't move, but
well, when you go to pick up something from the ground,
you're floating all your spine on that you're bending back,
which then is what we were talking about earlier in the
(22:05):
interplay between genetics and wear and tear.
Well, if you have poor hamstringmotion or hip motion, then
you're going to put a lot more load and it's just the cycles of
life. Eventually you're going to
accelerate that and, and, and cause problems, right?
Right. So to summarize this, I would
say your spine loves motion, right?
Long stretches of sitting in theSouth position is like, it's
(22:28):
like a rust for your back, right?
Short and frequent movement and breaks and basic strength work
are some of the best medicationsreally we have for our spine,
right? Because there is no good
medication that's going to solvethis issue.
Patients are always asking me doc, well, what, what can you
give me? And it's going to like, so I
don't have this backache anymore.
(22:49):
You know, the problem is these medications they all have, they
all have their trade-offs. And if you don't go to the root
cause of the problem, yes, we can give you medication to help
reduce inflammation, but those medications also have side
effects. So they're not a good long term
solution. The long term solution is
prevention. So you can stay out of my
office, right? I mean, that's really the other
(23:11):
part of this is ergonomics. We talked about this a little
bit. We talked about the desk setup,
you know, screen being eye levelgood lumbar support, You know,
you can even put you know, thesechairs I'm sitting on right now
has nice support back here, but you can put a roll of towel to
make sure that arch of your backin the lower back as well
supported, you know, hinging at the hips when you're going to
(23:36):
pick some things that he'll be talking about mechanics.
Now you can do a lunges squatting, right.
That's where knowing how to do aproper squat is so important
because that's really how you should be sitting and then
sleeping, right? You want to have a good firm
mattress to support your back. So that is your back isn't
slouched in side steeping versus, you know, back sleeping
(23:57):
is a huge question I get all thetime.
I think black is obviously ultimately better because if
you, if you're a slight sleeper,typically you're just sleeping
on one side. So then you're going to create a
differential force over many, many cycles that can be harmful,
right? So back sleeping in a good firm
mattress that gives you good support is very, very critical.
(24:21):
Then we, you know, the lifestylefactors is the last pillar of
this right Weight control. You know, it sounds obvious, but
you know, but, and that may be obvious to me, right?
The problem with extra weight, especially if you're carrying it
in your belly is the more force you're putting away from your
(24:42):
gravity center of gravity, the more stress your spawn has to is
withstand. And so it goes back to that
interplay with within wear and tear and genetics.
Well, the issue is weight problems is partly genetic too,
right? So that's where it gets very.
Complicated. Right now, there's been
(25:02):
tremendous obviously progress over the past, I would say
decades, especially with now theGOP direct medication where
that's helped. But ultimately those are just
medications to help you get to abetter, you know, to basically
dial down that thermostat. But you still have to make some
of those lifestyle choices like eating better, exercising
(25:24):
better. You know, we didn't talk about
sleeping yet, but sleeping is socritical to spine.
How? Because it allows your disks to
rehydrate, it allows for your immune system to regain its
function because everything in life and every disease process
it within the spot with the body, including the spine is
this fight between inflammation,anti inflammation and right.
(25:47):
And so steep is very critical toreduce your stress levels and
allow your body to recover. And so we want to be active, but
we also want to give our bodies some time to rest.
And that's when you get, you know, good night's sleep is
critical. And some, some people need 6
hours, you know, I can go by 6 hours.
Some people really need 8 hours.That's where the genetic
difference is. Also to play, you know, the last
(26:11):
thing I would give the audience is, you know, break it down to
simple and maybe one or two simple things that you can do
every day, right? That's part of your routine.
You know, one thing that I like to do is after every meal, go
for a walk. This is just, you know, five
minute, 10 minutes something because that's actually the, the
(26:35):
time point where your glycemic index, the sugar levels in your
bloodstream is going to shoot upbecause you just had food.
And that's what you want to try to modulate as much as you can
because that's where the cascadeof your body needs to then bring
the sugar levels down. It's going to pump gluten
insulin in your bloodstream, which is the hormone that's
(26:57):
meant to reduce your your glucose level, which then causes
some of these other issues, right.
Because insulin is also what triggers your body to want to
absorb everything and, and, and,and store fat.
So that's why I like high fructose corn syrup or high or
foods that have a high sugar content.
(27:17):
No, not just high sugar content because sugar that rapidly gets
absorbed and increases what we call the glycemic index is so
harmful. And so having some routine such
as walking right after a meal, stand up and walk during phone
calls, right? Simple things that you know,
(27:38):
these are things that if you make it a habit, then you're not
even thinking about it doesn't sound like work where you get
you got to go to the gym. You know, those are things that
patients can do to help with that prevention piece that we
talked about. Any questions on this topic
before? Yeah.
Before we move on, this one I think is pretty universal
(27:59):
because anybody who listens to this is probably experienced
this, but I'm going to ask you, but we had an episode back about
digital posture dysfunction and the tremendous effect that
phones or smartphones have on deep cervical flexion.
What do you make of this? Because I'm saying this way more
(28:22):
with clients, with students, really young people who are
like, my neck is killing me because they're always just
looking down all the time. Are you saying this a lot in
your practice? And if you whether if you are or
aren't, what's your suggestion on this?
Because this is something so many people do and they're
looking for ways to break out ofit.
(28:43):
Yeah, I, I think it's one of those I, I, I have seen it more.
This question has definitely come up multiple times.
I experienced it myself as a surgeon, just because we look
down a lot. And one trick that we have is,
you know, we can wear these, we wear these loops that these
magnification glasses. And so I had to get them
(29:03):
adjusted so that you're looking here, but you're looking down.
It has like a right or I use themicroscope, which then allows
you to basically stand like this, like straight ahead,
looking straight ahead, but you're looking down, right.
So 100% looking down, whether that's your phone, you know,
depending on your occupation is going to create increase strain
(29:27):
on the muscles, the ligaments and the disc in your neck and
cause problems. And so there are habitual things
that you can do, everyone can doto help solve that problem.
For example, they're holders forthe phone.
Like I have one right here, you know that you can set your phone
that elevates it so that you're not looking down.
(29:48):
If you're sitting on a couch or a chair, you know, holding your
phone up or having a again, a place for it, let's say on the
kitchen counter or on the table,you get to elevate it.
So there's things where you can do to help.
Try to minimize that as much as possible because there's no
reason why you can't use your phone without just constantly
(30:10):
looking down, right? I think technology is also
getting better, right? With the, the AR glasses.
I think some of that there are solutions.
I think the first step is recognizing as a there's a
problem, right? And hopefully the audience
listening to this is because a little bit more mindful about
(30:30):
those type of habits because again, it's the key is
prevention, right? Because once you recognize
there's a problem and then now you're thinking about the goal,
there's a solution. That's right, for sure.
So I wanted to talk about what, what do I, what do I do?
How do I approach patients with spine issues?
(30:52):
And ultimately it comes down to the story, the patient's story,
their journey with the understanding the onset, where,
where is the pain? What activities worsen, relieve
it? What, what do they do for a
living? What are they, what are their
hobbies? What are the, what are their
goals, right? Because if you don't understand
the story, you don't really knowwhat the goal here here is.
(31:13):
And without a goal in mind, likeI said in the beginning, you,
you're sort of lost, right? A lot of times patients, you
know, have come to me. Well, I got this whole body MRI,
right? They had the, you know, they're
doing longevity care and they're, you know, and they're
freaking out because, you know, the radiologist wrote all sorts
(31:34):
of, you know, jargon there that they can't understand what this
is broken down, not broken down.But the MRI is just a picture.
It doesn't tell you the story. You can have an MRI where all
the discs are worn out and the patient has no pain.
They're, you know that they're fine.
They're, they're doing their activities, they're going on
(31:57):
their vacations, they're going to work to take care of their
family. They have minimal discomfort.
Then you have another person with MRI where only one disc has
a problem and they're in debilitating pain.
I mean, they, they can't even dothe basic things around the
house, let alone go and work outor, or, or have their hobbies in
place. So at the end of the day, the
number one thing is understanding what is the
(32:19):
patient's story. You got to meet the patient
where they are, understand theirgoals.
Obviously, we're going to examine them, look at as many
data points as possible to then try to correlate the clinical
picture with the physical and video graphic findings, right?
(32:39):
Because you want to understand what the structural problems
are. But you want to understand well
out of all these structural issues because some of it is
normal wear and tear. Well, what's actually causing
the functional issue so that youthen then come up with a correct
diagnosis to understand well, what's what's causing this
patient's suffering and how can I help them?
Because if you don't get down tothat nitty gritty aspect,
(33:04):
there's so many solutions and toperfectly get the best result
for our patients, we're trying to match the best solution,
right? If, if, if, if a physician or
surgeon just has one tool and they, you know, unless the
screwdriver fits for every problem, that's all they can do,
then they're very limited, right?
(33:25):
And unfortunately, either they can't help the patient or they
do the wrong thing for the wrongreasons.
So we really want to make sure that even before we go down to
the surgery aspect that we have a non surgical toolbox.
And that's really what differentiates myself and the
practice is we have a huge focuson holistic care, physical
(33:46):
therapy, drying, needling, lasertherapy, hyperbaric therapy, all
the way to regenerative treat therapies like PRP that's play
that rich plasma that's obtainedfrom the from the blood or bone
marrow concentrate because thesehave growth factors and very
anti-inflammatory effects. And for the right right issue,
right structural problem, let's say a tennis elbow or a golfer's
(34:09):
elbow or Achilles tendonitis where it's of collagen fiber
disorganization, PRP can be an excellent solution or for small
annular fissures within the discand the bone marrow concentrate
can be very life changing. And really avoid surgery if you
know, once you've addressed mechanical physical strength
(34:29):
issues with good therapy, right?So you really have to have the
the ultimate, I would say non surgical toolbox, you know, to
be able to make sure that you'reproviding the patient with all
these different avenues to really try to avoid surgery if
you can, right? Can surgery be an option for
(34:51):
certain individual? Yes, right.
If there's a structural issue that's causing major neurologic
issues or there's a structural issue is just causing major
instability for the spine, or there's a structural problem
where it's too far gone to do the regenerative treatment.
Let's say that's worn out, is that's not functioning well
anymore. Can we replace it right?
(35:11):
In motion preservation, a surgery is one of the areas of
my expertise where we can take Aand let's say a damaged disc and
put a prosthetic that now moves,right?
Believe it or not, that's been around for a long time.
But in the US, are you less than5% of surgeons still do it
routinely? You know, we can definitely get
(35:32):
into why, you know, it's, it's, it's harder to do it.
It's there's a reimbursement issue with a lot of insurance
companies. So Europe is, you know, far
ahead of the US in this respect.But there are few leading
centers, including ours, where we do a lot of this replacement
surgery with very high level of success.
Because at the end of the day, you have to do a lot to be good
(35:53):
at it. You have to understand when is
when is the patient appropriate for it.
You have to have the whole gamutof the regenerative options and
non operative options to then make sure the patient gets good
results. Because even with surgery, if
you don't have good pre rehab and post rehab and recovery
program for the patient, you're not going to get a good result.
The cover he's is such a big part of that.
(36:16):
And so you know, that's sort of my philosophy and approach in
terms of how I approach that patient.
And you know, when is it elective?
When is it really an emergency? You know, it comes down to
infection, newer major neurologic issues, you know,
obviously those are urgent. We got to you got to take care
(36:36):
of it. You know, there's no question.
But most of it that becomes surgical as well, like elective.
We've exhausted some of these other options.
And then the questions of how dowe, how do we provide the most
cutting edge option that helps our patient get back to the
function that they want? What are the goals with with
longevity, right? I'm not interested in doing
something that I know in a year or two that thing's going to
(36:58):
fail, right? So want that perfect balance
between the least amount of downtime.
But I also want to give a solution that has longevity for
the patient. What did I want to make sure
that this part is well covered before we go on to the next
(37:19):
part. The last area that I wanted to
cover was some of the sort of the myth busting, some of the
common misconceptions that I that.
Would be great actually because I know where I want to respect
your time and and I know we're here for an hour and so we have
like 8 minutes left so I want tomake sure we get to so.
(37:42):
Let's talk about the myth busting and then we can wrap
this up. It's been a very good
conversation. So I'll give you some some some
of them. One is, well, if I have a
herniated disc, that means, you know, I need surgery.
Well, in fact, that's not true, right?
Not more than 90% of this herniation they can get, They
can get shrink, they can get smaller.
(38:02):
It really depends on the herniation and the subtype of
it. The disc isn't just one, one
thing is actually the cushion that we were talking about has a
outer shell that's much more firm and gives the tensile
strength to the to the disc. And then there's an inner piece
called the nucleus pulposis, which is much more gelatinous.
(38:24):
So if there's a tear in that outer ring and that the little
Jelly comes out, that actually has a much better prognosis of
getting better without surgery, right?
Because the body, the macrophages, those little
inflammatories cells can go eat it up.
So as long as there is not causing major nerve issues like
weakness and foot drop, a lot oftimes what we're trying to do is
(38:45):
really try to temporize the pain.
We can do injections and therapyto try to buy the person time.
It's kind of like when you get acold and we're doing all this
home remedies to essentially just give your, your, your
immune system a chance to kick, right.
And so that's a, you know, 11 area of, of that I get all the
time. The other is well rest is the
(39:06):
best treatment for back pain, which is not really true.
In fact be too stationary for most instances.
I don't want to say for everything to move it is
actually better right? So I even if it hurts a lot
better to move. Sometimes I'll get my patient
into something called Aqua therapy or just get to get in a
pool just walk in a pool becauseyou know the water takes away
the gravity and so then the patient can move.
(39:29):
So movement is usually better. Another one is we kind of
touched on this a little bit before, but my MRI says I have
all these degenerative changes so my back is ruined, you know.
Well, no, most we all, you know,we talked about the wear and
tear and we all are going to have some physiologic normal
(39:49):
wear and tear that happens no matter what.
And so again, MRI is just a picture.
It doesn't tell you the story. Another area is another myth
that I hear all the time as well.
If it has, you know this. Cousin of mine or this friend of
mine had, you know, 4 surgeries now.
Well, then, you know, back surgery gets really bad name for
(40:11):
multiple reasons, but one of them is well, they had back
surgery, then they had another one.
Well, it's you know, the first surgery then caused the second
one in, in the mind of the of the public.
That's what's happening. You know, a color to that is,
you know, you, let's say you, you, you're, you're prone to, to
dental cavities, right? You get your, you get a cavity
(40:31):
in one year and 3-4 years later another one pops up and you get
another cavity filled. Well, for some reason that's
very understood because we understand well this is 11 tooth
and now it's another one that, you know, it's not like the
dentist caused the other cavity.Yeah, the spine people see it as
one unit, but it's really is multiple segments just like your
(40:54):
teeth are. And so some of the issues is
that it's just a natural progression of disease.
And so a lot of time the reason people are having multiple
surgeries over let's say a 20 year period is because another
level just breaking down. Yeah, the same underlying issue
whether that was genetics, activity, lifestyle choices is
(41:19):
some of that is from that. Now, there are ways to do things
like, you know, we talked about motion preservation.
If you can maintain motion, you're going to reduce that
progression, right? So that's better than a fusion
or the way you even do the fusion surgery itself can be
done in a much safer way now, like robotic technology doing
the spine that the surgery from the front of the spine with it
(41:40):
where you not have to go throughmuscles.
So there's ways to not add to the problem.
But that is a huge misnomer that, OK, if I have surgery,
that means I'm essentially destined to get another one.
So it's, the answers are way more complicated than that.
And so I wanted to make sure I, I sort of addressed that because
(42:02):
I hear that all the time and, and, and it's good for the
audience to hear that. So to summarize this segment,
you know, I want you to, I want the audience to come away with
understanding what the spine does, what are the common
patterns of breakdown, right. So we talked about form, you
(42:24):
know, function flexibility, core, right?
You want to maintain that good core.
You want to build your trunk before you build your
extremities. The goal is spine health, not
the Max weight that I can do. So you have to have good, like
we stretch out warmth, warm up first, work up to a comfortable
(42:46):
weight where you're not losing your form.
We talked about protection by moving regularly, strengthening,
watching your pasta posture, your economics in everyday
habitual tasks, Right. In terms of how do we respond to
it? You know, don't panic it with
pain. Yeah, it's very common.
(43:09):
Adults in the US up to 60% have some severe bouts of back pain
or neck pain because of of this underlying aging that happens.
But definitely seek help, you know, make sure that the center
that you're going to as well blur with all the conservative
options, right? There's a lot of very advanced
(43:31):
tools now within physical therapy and physiatry, within
spine institute like ours, ours that sort of has has all has it
all is sort of what you want to be looking for so that you're
not getting pigeon holed down to1 path and only one solution.
(43:51):
You know, surgery is just a tool.
It's not a failure, right? There are specific situations
where the benefits do outweigh the risks.
You know, it could be a successful, a very life changing
thing. And one of the most gratifying
things I can do is get someone from point A to point B where
we've exhausted some of these other options.
(44:12):
And so, so you know, I'll, I'll,I'll leave you with this, you
know, if you're, if you're dealing with back or neck pain,
remember, your spine is not broken.
Just pick your MRI has some big scary words on it.
There's a lot that we can do before surgery.
And, and when the surgery is theright tool, it's because we've
carefully matched the problem with the solution, right?
(44:33):
So I hope the audience enjoyed the segment and took away from
it. Again, my name is Essan Jazini
and here at Virginia Spine Institute of VSI in Northern
Virginia. Thank you, Doctor Gizzini, that
was awesome. So many people are going to
benefit from this, me included. I'm so happy that you gave us
some of your valuable time. I know you're off and running to
(44:56):
the next patient in the next discussion, so thank you so
much. I appreciate you tremendously.
Got it, Thank you for having me and enjoy your rest.
You got it.
All right, well, we have an awesome episode here today and
I've been looking for a while for someone to talk about spine
health with all of the differentaudiences that I work with, from
students to colleagues to clients.
And so I'm pretty pumped that Doctor Gesini is here to talk
about spine health. He's been very busy coming from
(00:22):
patients, surgery to all these things.
Thank you for giving me some of your very valuable time to
discuss this, Doctor Jezzini. You're welcome.
I'm very happy to be here and and to speak to you.
This is very obviously a very important topic.
Obviously as a spine surgeon, this is what I do each and every
day. And so I'm happy to share my
(00:43):
sort of thoughts and and expertise on this topic with
with you and your audience. Excellent.
No, it's great. And and we're going to focus
this today really on starting with the the basics as I talked
to Doctor Giazzini and Discoverycall, I do with all of the
guests here, love to get to knowthe guests, but we really want
to not jump too far ahead too quickly, but create an
(01:07):
operational definition of what we're actually talking about
with the spine. So Doctor Giazzini is going to
talk a little bit first about the basics of the spine
structure, function, Physiology,and then we're going to move on
from there. Yeah, I mean, I think a good way
to sort of sum up what we're going to talk about today is
that this is really spine healthone-on-one from prevention all
(01:28):
the way to surgery. I'll start with just introducing
myself to your audience. And Dr. Bazini, I'm a spine
surgeon here in Northern Virginia right by DC at Virginia
Spine Institute, also called BSI, which is a practice has
been around for 30 years. What's really unique about
myself and this practice is thatwe are all inclusive Spine
(01:48):
Institute. That means we have both
surgeons, but physiatrist, neurologist, the physician
assistants, physical therapists all working together really to
help with spine healthcare. Most of what we do, even though
I'm a surgeon is actually non operative care all the way from
physical therapy to regenerativetreatments to surgery, right?
So my interest today is to sort of lay out what is spine?
(02:13):
What's the function and structure like as you said for
spine. And you know, most of us don't
think about a spine until it hurts, right?
So what we want to do is to talkabout what it actually does, why
it starts to break down in some people, what we you need to do
to protect it, right? And what I do as a spine surgeon
(02:34):
when things don't go as well, right?
And so that's so the goal here. So talking about sort of the
structure and function of spine,it's best to sort of first
build, I would say a mental model for the audience, right?
And the best way to understand it is, well, what, what is it
doing, right? It's a spinal column, right?
(02:56):
And So what that means that it's, it's, it's the foundation
for your head and your torso, right?
It allows us to be upright animals, right?
That's how we can stand, right? That's how we can function.
The other aspect of it is the spine.
As most people know, it's not like nice and straight like
(03:17):
this, right? It has curvatures, right?
That curvature is built in that way in order to provide a spring
like effect. It's a shock absorber.
I'll talk about the entire structure of the spine.
Then within those columns, right, you have the vertebral
bodies which are basically stacked one-on-one top of the
other. You have the things that are
(03:39):
called discs. Those are the cushions that also
provide that cushioning, right? The other function of the spine
is that it's provides a tunnel, a Bony tunnel that protects the
very vital thing called the spinal cord that sends the
information from the brain to our extremities and to the OR
(04:02):
other organs, right? And so it's like that inner cage
that you can see pretty much in a lot of the other animals as
well that supports and protects that.
The last thing that in terms of structural standpoint is the
functionality piece of it. It allows us to move.
It's not a rigid piece that justdoesn't move, right?
(04:25):
Each of those segments move on top of each other in a very
rhythmic but also systematic way, right?
That allows you to bend, just twist to look right?
So we can then break it down into the individual main parts
of the spinal anatomy, you know,and these are terms that I'm
(04:47):
sure a lot of audience members have heard, like what's a
vertebral body, right? Really what it is, is those
building blocks of bone that arestacked between those cushions
called the disc that we just talked about.
Then you have the fasted joints,which are the hinges.
They're the small guide rails inthe back of the spine that
(05:07):
allows that motion, and those joints in different parts of the
spine allow different degrees ofmotion, which is important as
well. Then you have the ligaments and
muscles, which are like the guy wires and active stabilizers.
And finally, you got the nerves,those things that send the
either the power to our muscles or the sensation from the legs
(05:32):
or the hands, fingers back to the brain, right?
So you know, you want to think of your spine like a flexible
skyscraper, right? The bones are the floors, the
disc of the cushioning between them, the joints and ligaments
are the connections and the muscles are the constant act of
support, keeping it upright and moving smoothly, right?
I just want everyone to sort of get the mental picture as we go
(05:56):
down to the next topic, which is, well, why does it break down
right? And you can really split this
into two different aspects, right?
You have the normal wear and tear and then you have southern
events like a traumatic event, right?
The reason I got into spine is from a that from an event like
(06:17):
that. My brother got into a really bad
car accident as a family and he had multi Poly trauma, you know,
brain injury, spine injury and really seeing doctors get him
back to where he is now, it really inspired me to do the
same, right? That was a calling for me as a
spine surgeon. But for most people it's not
(06:37):
traumatic. It's really normal wear and tear
where it gets a little bit more complicated as genetics, right?
Ultimately we're all we are to some degree.
Our genetics is defined us as people, right?
And so where that becomes a hugefactor is in some people that
normal wear and tear that happens starts at an earlier age
(07:00):
versus you have a more of a propensity to have disk issues
at a younger age. So then as that normal wear and
tear happens, you know, they had, they start having problems
in their 20s and 30s versus let's say in their 40s and 50s.
But that wear and tear happens no matter what.
It's like, you know, you drive acar, the tires eventually will
wear out and the more you drive that car, you're going to wear
(07:22):
it out faster. You need to change the tires
now. They're different brands of
tires. So some people are with the, you
know, the top notch tire and so you can last a little bit
longer, but at the end of the day, it's going to wear out if
you drive it long enough, right?Do we know like the difference
like percentage wise genetics, terms of populate like I don't
(07:44):
want to say this like how big ofa genetic contribution is there
to the wear and tear between individuals?
It's not simply because there's an interplay where, you know,
the, I would say if you say, heyman, give me a number, I would
say it's probably 7030 genetics to wear and tear.
But it's a little bit more complicated than that because
(08:06):
there's an interplay between your activity and your genetics.
And what I mean by that is the same person who has the P
disposition, they will actually that genetic aspect will be
accentuated with with poor mechanics or let's you know what
I mean? Like let's say think about like
a football player was a linebacker, right?
(08:29):
Those are guys are taking a beating to their spine, right?
The guy with really poor genetics for their disc will
have way more of acceleration than the person who doesn't.
So it's probably more like 9010 in that scenario, right?
So that that ratio will change depending on your habits,
lifestyle choice choices and howmuch, you know, load you're
(08:51):
putting on your spine. So but genetics is a huge part
of it, OK? It doesn't mean that there's
nothing we can do about it, right?
It actually means there's, it makes even more important for
you to make those good choices and for us to guide our audience
in terms of, and what I want to do with my patients and educate
(09:12):
them because prevention is all ultimately the key, right?
So getting to the sort of nitty gritty of like a what's breaking
down, you know, we can break it down into those structures.
So the disk is soft, those cushions degenerate because they
lose water content over time. There's a process called
glycosylation where the collagenfibers in within the disk
(09:36):
itself, sugar molecules are attaching to them and it's
making them dehydrated, it's making them stiffer, which then
causes stiffness, right? The joints, those facet joints
we talked about earlier, they lose their cartilage, they lose
their fluid, they lose their lubrication, which then causes
stiffness and pain. Then you have the muscular
aspect of the of the spine that we talked about and poor
(09:59):
mechanics like a weak core or hip and you know, tight
hamstrings, prolong sitting, a forehead posture, heavy
repetitive lifting. These are where the contribution
comes from those structure. And ultimately then there's the
lifestyle factors, things that are, you know, sounds obvious,
right? Obesity, smoking, sedentary
(10:20):
lifestyle, heavy repetitive lifting, right, or poor lifting,
right? Like think of deadlifts like
I'm, I love to be fit. I you know, I did, I've done
CrossFit, I've done other works forms of workout and a lot of
those injuries happens from poorform, right?
Deadlift is actually a great exercise, but done poorly.
(10:42):
It's it's horrible for your back.
That load is going to be concentrated in, in that
especially the the lower disc that cushion in in your lower
back. So, you know, to summarize this
section, I would say most spine problems, right, aren't one huge
injury. There is slower drip of stress
over years and years, sitting a lot, not moving enough, lifting
(11:05):
or working out with poor mechanics and sort of the normal
aging of the disc and joints, right.
That that's a way to sort of summarize that, you know, that
aspect of it. Then we want to sort of get to,
well, what's the, the southern structural problems that we see,
the traumatic things that we see.
And it's not always like a high velocity injury like, you know,
(11:26):
my brother suffered from, you know, 1 terminology that a lot
of patients have heard of is like this herniation.
Well, that's really just that Jelly.
That cushion is pushing out and irritating a nerve, right?
If it hits a nerve, you'll feel it down your arm or down your
legs. If it's more central, you may
just have severe back pain that's very debilitating,
causing severe pain. You can then develop as a result
(11:50):
of that something called spinal stenosis, which is the narrowing
of those nerves, which is essentially a blood flow issue,
right? If they don't have as much room
to breathe, well, guess what? You're going to have trouble
with standing and walking because it's a perfusion
problem. It's like you're, you get chest
pain. If you're, you're not getting
enough blood supply to your own heart, right?
You get a get a heart attack. But initially when it's not as
(12:12):
bad, like you'll get some exertional chest pain, let's say
going up the stairs, then they're the same thing.
They're going to give the signalback to you to say, hey, there's
a problem by hurting when there is not enough perfusion there,
right? Then you can have instability.
Something called spondylolethesis is a Greek term
that means one vertebra, one building block is shifting in
(12:33):
front of the other one, which can cause nerve pain and pain,
just mechanical pain, right? Then going down to the more
traumatic aspect of things, right, you can have trauma or
let's say compression fracture where the bone itself actually
has failed from mechanical stress.
Now, either because the stress was was high enough to cause the
(12:55):
fracture or the bone was weak, right?
So building and maintaining a good bone density is a critical
part of a good spine health. And I encourage all my patients
to be very proactive. As a society, we're a little bit
reactive in medicine, unfortunately.
And we sort of wait until the patient's 60 years old to tell
him, wait, listen, you're, you know, the past 30 years you've
(13:16):
been losing a lot of bone density will not do something
about it where now you, you know, your options are more
limited, right? But if we can encourage patients
to do weight bearing exercises and really load their spine and
their bones and make sure that you know, if there's hormone
deficiency, vitamin deficiency, some of the identifiable causes
(13:37):
can be reversed. It's much better to do that head
on at an earlier age than to wait until you're in your 60s to
then try to medicate yourself out of that, right?
And then we don't want to forget, forget about the red
flags, right? Things like history of cancer,
unexpected weight loss, infection, fever, night pain.
(13:58):
These are things that obviously you want to see someone quickly
because those are not routine things that should be missed,
right? You want to make sure that our,
our, our, our, our audience is educated on that, right?
Before I go to the next section,I just wanted to kind of make
sure that you had no other questions.
I have tons of questions man. I just think.
(14:21):
But my goal always is I want theexperts to talk and give their
expertise and then I jump in when appropriate.
But we mentioned about spinal loading.
This is something I want to get your opinion on, your expert
opinion here. So you're talking about dead
lifting and my audience is obviously students, anatomy
students are going to be in different healthcare jobs, but
(14:44):
it's also personal trainers and different clients.
So there's a lot of opinion out there about spinal load and
compression on the spine. And actually a lot of my
colleagues who are very educatedon moving away from a lot of
heavy spinal loading with Olympic lifting bar, you know,
(15:05):
dumb barbell squats, educate us on this, on what is potentially
effective in doing this and whatcould be a tipping point for
being not effective and actuallycausing harm to the spine with
with loading the spine. I think ultimately it's it's
it's in some ways it's complex, but some in some ways simple.
(15:27):
If you cannot maintain proper form on every single Rep, then
that weight is too much. So ultimately what you need to
do is first work on your flexibility, then work on the
strength, and then build up to an appropriate level.
(15:48):
I'm not a big fan either of heavy, heavy loads.
Yeah, because life is a marathon, right?
We're not trying to do the Max load that you can do.
I mean, I don't at the end of the day, you know, one of my
mentors always says the end, theend goal should be the first
thing in mind. If you know what your end goal
(16:10):
is, then you figure out, OK, what do I need to do achieve
that, right? And so the goal here is good
health. The goal here is bone,
maintaining a bone density, maintaining your flexibility,
maintaining function. And so I'm not there working out
to impress anyone. And unfortunately what happens
(16:31):
is we are all competitive. I'm I'm super competitive as
well, right? And you're especially some of
these classes, right? You're like putting Max weight,
Max rap. And that's where we forget
people get into trouble, right? But super athletes get in
trouble because they're exhausted, they're fatigued,
(16:52):
they're trying to get to certaintarget weight and then their
form is off and it doesn't take much.
Your form is out, you have this,we just talked about this normal
wear and tear. And so it doesn't take much for
you to be over that tipping point, right?
So does it help answer that question He gets because then
(17:13):
you have to sort of watch it's very individual, right?
Some people have poor ankle motion, some people have poor
hip motion. So for me to be able to then
just guide big picture, it's impossible, right?
You know, getting a trainer, working with a trainer, really
individualizing it to each person is critical.
(17:36):
There is not a one-size-fits-allhere.
But if you have that guiding principle of maintaining
flexibility that were you neededto do that proper exercise is
key, right? And you've developed in our
practice something called like blood flow restriction, right?
You have athletes that can't, let's say, do a certain load
(18:00):
safety right now because of the injury.
Well, there's a waste. There's Cheat Sheets around
that, right? You can restrict the blood flow,
trick the body to be able to getthe same results by restricting
some of that blood flow, right? So there are other very advanced
ways that we can achieve those results, right, without causing
undue stress to the spine. And so that's the key is at the
(18:21):
end the goal is spine health or physical health in, in, in this,
in this, when it comes to this question, but how do we achieve
it without causing another problem, right?
It's actually flows really well into the next topic, which was
prevention and sort of everyday health, spine health, You know,
what do we, what can I do beforethey, someone can meet me in the
(18:43):
clinic, right? 1 one area is really sounds kind
of obvious is just regular movement.
You want, you don't want to be sedentary.
You're right, you don't want to,you don't want to sit for more
than 30 to 45 minutes. So one area where I've seen a
lot of improvement is, you know,patients, you know, a lot of
patients now have stand up desk or this desk that go up and
(19:05):
down. So they're not in an office.
You know, as a surgeon, I'm not sitting down much, right, Just
because of I'm operating, I'm going between rooms seeing
patients. But that could be a lot more
challenging for someone who sitsat a desk, right, in a cubicle
or an office, right? So I think a stand up desk, you
know, they have those walking treadmills now where you can
(19:26):
stand and actually move your legs.
Body is meant to be moving and the more stationary it is, the
more static it is. It becomes more prone to injury
because those joints become stiff, the disc becomes stiff.
They don't hydrate well when they're stationary.
And then you get up to go do something very, very medial,
(19:49):
like very ordinary. And that's how people actually
injure themselves. It's usually not, hey, I went
and did a deadlift and boom, I'minjured.
I've been over to brush my teeth.
I've been over to pick up the trash.
It's it's very mundane. I hear that all the time.
Too right? It's so, but the way you prevent
it is by moving. Keep yourself moving.
(20:11):
And not just I'm talking about exercise, I'm talking about
everyday stuff, right. Strength training is a second
topic and sort of what we were talking about before, but really
focusing on the core. So do I love weight, weight
training, Olympic weight training, yes, but not before
you've you've built a really good core.
So I got into yoga six years agoand it's tremendously helped me,
(20:39):
you know, with my some of my ownpain that I have in my to my
shoulder blades, my back from standing as a surgeon bent
forward. So working on core and doesn't
have to be yoga. It could be Pilates is critical
because the core is what is the muscles that we just talked
about the supports your spinal canal.
And, and it's like a, you know, an analogy I give my patients
(21:00):
is, you know what, you see thosemassive trees with those massive
branches, while they can't have those massive branches if they
don't have a strong trunk, right?
It has to, right? It has to be proportional.
If you have a branch that's too big relative to the trunk, it's
going to fail, right? The trunk will fail.
And the spine is the same thing,right?
(21:20):
If, if you just go in the gym and you're just doing biceps and
triceps and shoulder press and, and like press, but you haven't
worked on your core, well, guesswhat?
You're going to injure your Yeah, you can do yourself right?
And so that's really important. And core doesn't just mean the
ABS. I'm talking about the back
muscles, the glute muscles, the and the stabilizers, the
(21:43):
scapular stabilizers are really important.
And then lastly, we talked aboutthis a little bit of
flexibility, right? Hamstrings, hip flexors, A
thoracic spine mobility, becauseif your hips don't move, but
well, when you go to pick up something from the ground,
you're floating all your spine on that you're bending back,
which then is what we were talking about earlier in the
(22:05):
interplay between genetics and wear and tear.
Well, if you have poor hamstringmotion or hip motion, then
you're going to put a lot more load and it's just the cycles of
life. Eventually you're going to
accelerate that and, and, and cause problems, right?
Right. So to summarize this, I would
say your spine loves motion, right?
Long stretches of sitting in theSouth position is like, it's
(22:28):
like a rust for your back, right?
Short and frequent movement and breaks and basic strength work
are some of the best medicationsreally we have for our spine,
right? Because there is no good
medication that's going to solvethis issue.
Patients are always asking me doc, well, what, what can you
give me? And it's going to like, so I
don't have this backache anymore.
(22:49):
You know, the problem is these medications they all have, they
all have their trade-offs. And if you don't go to the root
cause of the problem, yes, we can give you medication to help
reduce inflammation, but those medications also have side
effects. So they're not a good long term
solution. The long term solution is
prevention. So you can stay out of my
office, right? I mean, that's really the other
(23:11):
part of this is ergonomics. We talked about this a little
bit. We talked about the desk setup,
you know, screen being eye levelgood lumbar support, You know,
you can even put you know, thesechairs I'm sitting on right now
has nice support back here, but you can put a roll of towel to
make sure that arch of your backin the lower back as well
supported, you know, hinging at the hips when you're going to
(23:36):
pick some things that he'll be talking about mechanics.
Now you can do a lunges squatting, right.
That's where knowing how to do aproper squat is so important
because that's really how you should be sitting and then
sleeping, right? You want to have a good firm
mattress to support your back. So that is your back isn't
slouched in side steeping versus, you know, back sleeping
(23:57):
is a huge question I get all thetime.
I think black is obviously ultimately better because if
you, if you're a slight sleeper,typically you're just sleeping
on one side. So then you're going to create a
differential force over many, many cycles that can be harmful,
right? So back sleeping in a good firm
mattress that gives you good support is very, very critical.
(24:21):
Then we, you know, the lifestylefactors is the last pillar of
this right Weight control. You know, it sounds obvious, but
you know, but, and that may be obvious to me, right?
The problem with extra weight, especially if you're carrying it
in your belly is the more force you're putting away from your
(24:42):
gravity center of gravity, the more stress your spawn has to is
withstand. And so it goes back to that
interplay with within wear and tear and genetics.
Well, the issue is weight problems is partly genetic too,
right? So that's where it gets very.
Complicated. Right now, there's been
(25:02):
tremendous obviously progress over the past, I would say
decades, especially with now theGOP direct medication where
that's helped. But ultimately those are just
medications to help you get to abetter, you know, to basically
dial down that thermostat. But you still have to make some
of those lifestyle choices like eating better, exercising
(25:24):
better. You know, we didn't talk about
sleeping yet, but sleeping is socritical to spine.
How? Because it allows your disks to
rehydrate, it allows for your immune system to regain its
function because everything in life and every disease process
it within the spot with the body, including the spine is
this fight between inflammation,anti inflammation and right.
(25:47):
And so steep is very critical toreduce your stress levels and
allow your body to recover. And so we want to be active, but
we also want to give our bodies some time to rest.
And that's when you get, you know, good night's sleep is
critical. And some, some people need 6
hours, you know, I can go by 6 hours.
Some people really need 8 hours.That's where the genetic
difference is. Also to play, you know, the last
(26:11):
thing I would give the audience is, you know, break it down to
simple and maybe one or two simple things that you can do
every day, right? That's part of your routine.
You know, one thing that I like to do is after every meal, go
for a walk. This is just, you know, five
minute, 10 minutes something because that's actually the, the
(26:35):
time point where your glycemic index, the sugar levels in your
bloodstream is going to shoot upbecause you just had food.
And that's what you want to try to modulate as much as you can
because that's where the cascadeof your body needs to then bring
the sugar levels down. It's going to pump gluten
insulin in your bloodstream, which is the hormone that's
(26:57):
meant to reduce your your glucose level, which then causes
some of these other issues, right.
Because insulin is also what triggers your body to want to
absorb everything and, and, and,and store fat.
So that's why I like high fructose corn syrup or high or
foods that have a high sugar content.
(27:17):
No, not just high sugar content because sugar that rapidly gets
absorbed and increases what we call the glycemic index is so
harmful. And so having some routine such
as walking right after a meal, stand up and walk during phone
calls, right? Simple things that you know,
(27:38):
these are things that if you make it a habit, then you're not
even thinking about it doesn't sound like work where you get
you got to go to the gym. You know, those are things that
patients can do to help with that prevention piece that we
talked about. Any questions on this topic
before? Yeah.
Before we move on, this one I think is pretty universal
(27:59):
because anybody who listens to this is probably experienced
this, but I'm going to ask you, but we had an episode back about
digital posture dysfunction and the tremendous effect that
phones or smartphones have on deep cervical flexion.
What do you make of this? Because I'm saying this way more
(28:22):
with clients, with students, really young people who are
like, my neck is killing me because they're always just
looking down all the time. Are you saying this a lot in
your practice? And if you whether if you are or
aren't, what's your suggestion on this?
Because this is something so many people do and they're
looking for ways to break out ofit.
(28:43):
Yeah, I, I think it's one of those I, I, I have seen it more.
This question has definitely come up multiple times.
I experienced it myself as a surgeon, just because we look
down a lot. And one trick that we have is,
you know, we can wear these, we wear these loops that these
magnification glasses. And so I had to get them
(29:03):
adjusted so that you're looking here, but you're looking down.
It has like a right or I use themicroscope, which then allows
you to basically stand like this, like straight ahead,
looking straight ahead, but you're looking down, right.
So 100% looking down, whether that's your phone, you know,
depending on your occupation is going to create increase strain
(29:27):
on the muscles, the ligaments and the disc in your neck and
cause problems. And so there are habitual things
that you can do, everyone can doto help solve that problem.
For example, they're holders forthe phone.
Like I have one right here, you know that you can set your phone
that elevates it so that you're not looking down.
(29:48):
If you're sitting on a couch or a chair, you know, holding your
phone up or having a again, a place for it, let's say on the
kitchen counter or on the table,you get to elevate it.
So there's things where you can do to help.
Try to minimize that as much as possible because there's no
reason why you can't use your phone without just constantly
(30:10):
looking down, right? I think technology is also
getting better, right? With the, the AR glasses.
I think some of that there are solutions.
I think the first step is recognizing as a there's a
problem, right? And hopefully the audience
listening to this is because a little bit more mindful about
(30:30):
those type of habits because again, it's the key is
prevention, right? Because once you recognize
there's a problem and then now you're thinking about the goal,
there's a solution. That's right, for sure.
So I wanted to talk about what, what do I, what do I do?
How do I approach patients with spine issues?
(30:52):
And ultimately it comes down to the story, the patient's story,
their journey with the understanding the onset, where,
where is the pain? What activities worsen, relieve
it? What, what do they do for a
living? What are they, what are their
hobbies? What are the, what are their
goals, right? Because if you don't understand
the story, you don't really knowwhat the goal here here is.
(31:13):
And without a goal in mind, likeI said in the beginning, you,
you're sort of lost, right? A lot of times patients, you
know, have come to me. Well, I got this whole body MRI,
right? They had the, you know, they're
doing longevity care and they're, you know, and they're
freaking out because, you know, the radiologist wrote all sorts
(31:34):
of, you know, jargon there that they can't understand what this
is broken down, not broken down.But the MRI is just a picture.
It doesn't tell you the story. You can have an MRI where all
the discs are worn out and the patient has no pain.
They're, you know that they're fine.
They're, they're doing their activities, they're going on
(31:57):
their vacations, they're going to work to take care of their
family. They have minimal discomfort.
Then you have another person with MRI where only one disc has
a problem and they're in debilitating pain.
I mean, they, they can't even dothe basic things around the
house, let alone go and work outor, or, or have their hobbies in
place. So at the end of the day, the
number one thing is understanding what is the
(32:19):
patient's story. You got to meet the patient
where they are, understand theirgoals.
Obviously, we're going to examine them, look at as many
data points as possible to then try to correlate the clinical
picture with the physical and video graphic findings, right?
(32:39):
Because you want to understand what the structural problems
are. But you want to understand well
out of all these structural issues because some of it is
normal wear and tear. Well, what's actually causing
the functional issue so that youthen then come up with a correct
diagnosis to understand well, what's what's causing this
patient's suffering and how can I help them?
Because if you don't get down tothat nitty gritty aspect,
(33:04):
there's so many solutions and toperfectly get the best result
for our patients, we're trying to match the best solution,
right? If, if, if, if a physician or
surgeon just has one tool and they, you know, unless the
screwdriver fits for every problem, that's all they can do,
then they're very limited, right?
(33:25):
And unfortunately, either they can't help the patient or they
do the wrong thing for the wrongreasons.
So we really want to make sure that even before we go down to
the surgery aspect that we have a non surgical toolbox.
And that's really what differentiates myself and the
practice is we have a huge focuson holistic care, physical
(33:46):
therapy, drying, needling, lasertherapy, hyperbaric therapy, all
the way to regenerative treat therapies like PRP that's play
that rich plasma that's obtainedfrom the from the blood or bone
marrow concentrate because thesehave growth factors and very
anti-inflammatory effects. And for the right right issue,
right structural problem, let's say a tennis elbow or a golfer's
(34:09):
elbow or Achilles tendonitis where it's of collagen fiber
disorganization, PRP can be an excellent solution or for small
annular fissures within the discand the bone marrow concentrate
can be very life changing. And really avoid surgery if you
know, once you've addressed mechanical physical strength
(34:29):
issues with good therapy, right?So you really have to have the
the ultimate, I would say non surgical toolbox, you know, to
be able to make sure that you'reproviding the patient with all
these different avenues to really try to avoid surgery if
you can, right? Can surgery be an option for
(34:51):
certain individual? Yes, right.
If there's a structural issue that's causing major neurologic
issues or there's a structural issue is just causing major
instability for the spine, or there's a structural problem
where it's too far gone to do the regenerative treatment.
Let's say that's worn out, is that's not functioning well
anymore. Can we replace it right?
(35:11):
In motion preservation, a surgery is one of the areas of
my expertise where we can take Aand let's say a damaged disc and
put a prosthetic that now moves,right?
Believe it or not, that's been around for a long time.
But in the US, are you less than5% of surgeons still do it
routinely? You know, we can definitely get
(35:32):
into why, you know, it's, it's, it's harder to do it.
It's there's a reimbursement issue with a lot of insurance
companies. So Europe is, you know, far
ahead of the US in this respect.But there are few leading
centers, including ours, where we do a lot of this replacement
surgery with very high level of success.
Because at the end of the day, you have to do a lot to be good
(35:53):
at it. You have to understand when is
when is the patient appropriate for it.
You have to have the whole gamutof the regenerative options and
non operative options to then make sure the patient gets good
results. Because even with surgery, if
you don't have good pre rehab and post rehab and recovery
program for the patient, you're not going to get a good result.
The cover he's is such a big part of that.
(36:16):
And so you know, that's sort of my philosophy and approach in
terms of how I approach that patient.
And you know, when is it elective?
When is it really an emergency? You know, it comes down to
infection, newer major neurologic issues, you know,
obviously those are urgent. We got to you got to take care
(36:36):
of it. You know, there's no question.
But most of it that becomes surgical as well, like elective.
We've exhausted some of these other options.
And then the questions of how dowe, how do we provide the most
cutting edge option that helps our patient get back to the
function that they want? What are the goals with with
longevity, right? I'm not interested in doing
something that I know in a year or two that thing's going to
(36:58):
fail, right? So want that perfect balance
between the least amount of downtime.
But I also want to give a solution that has longevity for
the patient. What did I want to make sure
that this part is well covered before we go on to the next
(37:19):
part. The last area that I wanted to
cover was some of the sort of the myth busting, some of the
common misconceptions that I that.
Would be great actually because I know where I want to respect
your time and and I know we're here for an hour and so we have
like 8 minutes left so I want tomake sure we get to so.
(37:42):
Let's talk about the myth busting and then we can wrap
this up. It's been a very good
conversation. So I'll give you some some some
of them. One is, well, if I have a
herniated disc, that means, you know, I need surgery.
Well, in fact, that's not true, right?
Not more than 90% of this herniation they can get, They
can get shrink, they can get smaller.
(38:02):
It really depends on the herniation and the subtype of
it. The disc isn't just one, one
thing is actually the cushion that we were talking about has a
outer shell that's much more firm and gives the tensile
strength to the to the disc. And then there's an inner piece
called the nucleus pulposis, which is much more gelatinous.
(38:24):
So if there's a tear in that outer ring and that the little
Jelly comes out, that actually has a much better prognosis of
getting better without surgery, right?
Because the body, the macrophages, those little
inflammatories cells can go eat it up.
So as long as there is not causing major nerve issues like
weakness and foot drop, a lot oftimes what we're trying to do is
(38:45):
really try to temporize the pain.
We can do injections and therapyto try to buy the person time.
It's kind of like when you get acold and we're doing all this
home remedies to essentially just give your, your, your
immune system a chance to kick, right.
And so that's a, you know, 11 area of, of that I get all the
time. The other is well rest is the
(39:06):
best treatment for back pain, which is not really true.
In fact be too stationary for most instances.
I don't want to say for everything to move it is
actually better right? So I even if it hurts a lot
better to move. Sometimes I'll get my patient
into something called Aqua therapy or just get to get in a
pool just walk in a pool becauseyou know the water takes away
the gravity and so then the patient can move.
(39:29):
So movement is usually better. Another one is we kind of
touched on this a little bit before, but my MRI says I have
all these degenerative changes so my back is ruined, you know.
Well, no, most we all, you know,we talked about the wear and
tear and we all are going to have some physiologic normal
(39:49):
wear and tear that happens no matter what.
And so again, MRI is just a picture.
It doesn't tell you the story. Another area is another myth
that I hear all the time as well.
If it has, you know this. Cousin of mine or this friend of
mine had, you know, 4 surgeries now.
Well, then, you know, back surgery gets really bad name for
(40:11):
multiple reasons, but one of them is well, they had back
surgery, then they had another one.
Well, it's you know, the first surgery then caused the second
one in, in the mind of the of the public.
That's what's happening. You know, a color to that is,
you know, you, let's say you, you, you're, you're prone to, to
dental cavities, right? You get your, you get a cavity
(40:31):
in one year and 3-4 years later another one pops up and you get
another cavity filled. Well, for some reason that's
very understood because we understand well this is 11 tooth
and now it's another one that, you know, it's not like the
dentist caused the other cavity.Yeah, the spine people see it as
one unit, but it's really is multiple segments just like your
(40:54):
teeth are. And so some of the issues is
that it's just a natural progression of disease.
And so a lot of time the reason people are having multiple
surgeries over let's say a 20 year period is because another
level just breaking down. Yeah, the same underlying issue
whether that was genetics, activity, lifestyle choices is
(41:19):
some of that is from that. Now, there are ways to do things
like, you know, we talked about motion preservation.
If you can maintain motion, you're going to reduce that
progression, right? So that's better than a fusion
or the way you even do the fusion surgery itself can be
done in a much safer way now, like robotic technology doing
the spine that the surgery from the front of the spine with it
(41:40):
where you not have to go throughmuscles.
So there's ways to not add to the problem.
But that is a huge misnomer that, OK, if I have surgery,
that means I'm essentially destined to get another one.
So it's, the answers are way more complicated than that.
And so I wanted to make sure I, I sort of addressed that because
(42:02):
I hear that all the time and, and, and it's good for the
audience to hear that. So to summarize this segment,
you know, I want you to, I want the audience to come away with
understanding what the spine does, what are the common
patterns of breakdown, right. So we talked about form, you
(42:24):
know, function flexibility, core, right?
You want to maintain that good core.
You want to build your trunk before you build your
extremities. The goal is spine health, not
the Max weight that I can do. So you have to have good, like
we stretch out warmth, warm up first, work up to a comfortable
(42:46):
weight where you're not losing your form.
We talked about protection by moving regularly, strengthening,
watching your pasta posture, your economics in everyday
habitual tasks, Right. In terms of how do we respond to
it? You know, don't panic it with
pain. Yeah, it's very common.
(43:09):
Adults in the US up to 60% have some severe bouts of back pain
or neck pain because of of this underlying aging that happens.
But definitely seek help, you know, make sure that the center
that you're going to as well blur with all the conservative
options, right? There's a lot of very advanced
(43:31):
tools now within physical therapy and physiatry, within
spine institute like ours, ours that sort of has has all has it
all is sort of what you want to be looking for so that you're
not getting pigeon holed down to1 path and only one solution.
(43:51):
You know, surgery is just a tool.
It's not a failure, right? There are specific situations
where the benefits do outweigh the risks.
You know, it could be a successful, a very life changing
thing. And one of the most gratifying
things I can do is get someone from point A to point B where
we've exhausted some of these other options.
(44:12):
And so, so you know, I'll, I'll,I'll leave you with this, you
know, if you're, if you're dealing with back or neck pain,
remember, your spine is not broken.
Just pick your MRI has some big scary words on it.
There's a lot that we can do before surgery.
And, and when the surgery is theright tool, it's because we've
carefully matched the problem with the solution, right?
(44:33):
So I hope the audience enjoyed the segment and took away from
it. Again, my name is Essan Jazini
and here at Virginia Spine Institute of VSI in Northern
Virginia. Thank you, Doctor Gizzini, that
was awesome. So many people are going to
benefit from this, me included. I'm so happy that you gave us
some of your valuable time. I know you're off and running to
(44:56):
the next patient in the next discussion, so thank you so
much. I appreciate you tremendously.
Got it, Thank you for having me and enjoy your rest.
You got it.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.