Do You Really Need A Fusion? The Truth About Back Pain And Your MRI Results, Ahilan Sivaganesan, MD

Struggling with leg and/or back pain and overwhelmed by confusing MRI results? You’re not alone—and this episode is for you.

 

In this special episode of The Spine Pod, hosts Courtney Schutze and Brady Riesgraf rejoin forces with Dr. Ahilan Sivaganesan (Dr. Siva), a neurosurgeon building an all-encompassing spine program with Hospital for Special Surgery (HSS) at NCH in Naples, Florida. After creating a successful practice at Thomas Jefferson University in Philadelphia, Dr. Siva has taken a bold step into a new frontier—starting from scratch and building a spine program designed to treat the breadth of back and leg pain patients that all too often ‘fall through the cracks.’ His goal is to design a new-style spine practice, utilizing the whole spectrum of the care continuum—from conservative care options to surgical treatment methods, specifically aimed at addressing patients' needs earlier, more thoughtfully, and with more innovative options.

 

Dr. Siva offers an honest take on the realities of spine care today—especially for the millions of patients suffering from chronic low back pain who often fall into the category of "non-specific back pain." In this episode, he shares why it’s time for spine surgeons to reframe their role—not just as proceduralists, but as clinicians.

 

In the second half of this episode, Dr. Siva breaks down the difference between imaging findings and a true diagnosis. He outlines how to navigate complex radiology reports and explores how endoscopic techniques and motion-preserving implants can offer outpatient alternatives to the traditional spinal fusion. He also walks us through real patient images, demystifying common findings like facet degeneration, spondylosis, and spondylolisthesis, and how a thoughtful, diagnosis-first approach can radically improve care.

 

In this episode, you’ll learn:

• Imaging ≠ Diagnosis MRI results like “annular tear”, “facet arthritis”, and “stenosis” are just part of the story—and why diagnosis should start with your symptoms and physical exam, not your scan.
• Why So Many Patients Get Lost in the Care Cycle Many people with chronic back and/or leg pain get stuck in a frustrating loop: bouncing between PT, injections, or fusion recommendations—without fully understanding what’s causing the pain.
• How Comprehensive Spine Care Can Redefine the Surgeon’s Role Dr. Siva shares how he's reshaped his own mindset: from "what surgery can I offer?" to "what’s the root cause of this person’s pain?"—and how this shift is foundational to future spine care.
• The Emergence of Endoscopic Spine Surgery as a First-Line Surgical Intervention For well-selected patients with discogenic or facetogenic back pain, endoscopy offers an outpatient, motion-preserving early-stage alternative—without the drawbacks of traditional fusion.
• The Importance of Building Comprehensive, Fusion-Free Spine Practices Dr. Siva and his team are using this fresh start to create a more thoughtful, tech-forward, and patient-centered model for spine care—one that listens to patient goals and preserves motion whenever possible.
• Where You Fit in the Continuum of Care Whether you're at the beginning of your back pain journey or feeling stuck after years of dead-ends, Dr. Siva outlines a more personalized, stepwise approach—one that gives patients options before jumping to fusion.

 

With a passion for patient-centered decision-making, innovation in technique, and humility in practice, Dr. Siva is helping lead a quiet revolution in how back pai