Alexander Taghva, MD - Neurosurgery

03/15/2026

Spine surgeon’s go-to squat. The goblet squat keeps the weight in front so your spine stays upright — no barbell compressing your back. I break down my cues, why depth matters, and the one mistake I’m still fixing in my own form. Shoe trick for tight ankles included.
Talk to your doctor before starting a new exercise program. Work with a PT or certified trainer for individualized guidance.
Demoing on my

03/15/2026

The goblet squat is a spine-friendlier version of the back squat — especially if, like me, you have limited ankle mobility.
Because the weight is held in front of you, it’s easier to maintain upright spinal alignment. My cues: initiate by letting the knees track over the toes, then squeeze the glutes to drive the rise — legs, not back.
I use a shoe with a heel drop to help compensate for tight ankles while I work on mobility separately. It’s a bridge, not a crutch. Demoing here on my — great for dialing in form with controlled resistance.
Depth? Only go as low as you can maintain structure. Go too deep and you’ll see compensation — the classic “butt wink” (posterior pelvic tilt) — which loads the lumbar spine in a vulnerable position.
One quibble with my own form: I catch myself flexing my neck to look down. Chin should stay neutral. Work in progress.
As always — talk to your doctor before starting an exercise program, and check in with a PT or certified trainer for individualized form guidance.

03/15/2026

“Everyone is a deformity surgeon - either you are fixing it or creating it.” Here is a patient with an L4-5 fusion done elsewhere and a progressive coronal deformity above it. Always important to get full length X-rays when planning surgery on someone with a coronal or sagittal offset. The spine has to keep the head centered over the pelvis - if you fuse one spot, the spine will compensate elsewhere. I always check for leg length discrepancies, which thankfully this patient didn’t have. We were able to get this patient upright again with a two-level XLIF and posterior revision.

03/04/2026

Not all back pain comes from discs, nerves, or joints. Sometimes it comes from inside the bone itself.
The basivertebral nerve is a pain-carrying nerve that lives inside the vertebral body. When the disc wears down, the protective endplate breaks down with it, and the bone underneath gets inflamed. We can see this on MRI — it shows up as Modic changes, a bright signal inside the vertebra that tells us the bone is actively inflamed. This is vertebrogenic back pain.
Characteristics: deep, aching, midline back pain that’s worse with sitting and bending forward. It doesn’t shoot down the leg. It doesn’t follow a nerve map. It lives in the spine and it’s easy to miss if you’re not looking for it.
The fix: basivertebral nerve ablation. We thread a probe into the vertebra and use radiofrequency energy to ablate the nerve carrying the pain signal. We’re not fixing the disc. We’re not fusing anything. We’re cutting the telephone line that’s screaming “bone pain” to the brain.
Outpatient procedure. Data-backed: trials show significant, durable pain relief. For the right patient — the one with Modic changes on MRI and pain that hasn’t responded to the usual treatments — this can be a game changer.

02/26/2026

02/23/2026

Most neck pain isn’t a neck problem. It’s a delegation failure.
Your upper traps are doing a job they were never hired for — full-time shoulder blade stabilizer — because the deep stabilizers quit and the pecs tightened the leash. The neck pays the tax.
These are my Cervical Six. Six exercises that target the actual source.
1. Lengthening Chin Tuck — don’t pull back. Grow tall.
2. Wall Angel — the gap between your wrists and the wall is your pectoral debt.
3. Anti-Shrug — shoulder blades into back pockets.
4. Suitcase Carry — grip strength is inversely correlated with neck pain.
5. Occiput Wall Press — a whisper, not a shout.
6. Open Book — every degree of thoracic rotation you preserve is a degree your neck doesn’t sacrifice.
Three a day, consistently, beats six a day for a month.
Full breakdown with cues and dosing on my Substack — link in bio.
⚠️ Educational content, not medical advice. Consult your doctor before starting any new exercise program.

02/22/2026

Do GLP-1 medications help back pain? As a spine surgeon, I’ve seen patients get better, stay the same, and get worse. The reason nobody’s talking about: up to 40% of the weight you lose on these medications can be muscle. Your core stops bracing your spine and suddenly that manageable back pain becomes unmanageable. I call it the sarcopenia trap. Full video on YouTube.
⚠️ This is educational content, not medical advice. If you have been prescribed one of these medications by your physician, make sure you talk with them before altering or discontinuing how you use them. Don’t start any of these medications without physician guidance.

02/21/2026

I’ve been doing a lot of writing lately. My neck was killing me. Arms going numb. Then I realized — I wasn’t taking my own advice. Low-tech fix that solved it.
⚠️ Educational content, not medical advice.

02/21/2026

I’ve been doing a lot of writing lately. More on why that is to come.
I found that my neck would hurt. Sometimes my arms and hands would go numb. Then I realized I wasn’t taking my own advice — the same advice I give patients every week.
Tech neck is a real thing. Our shoulders roll forward, compressing the brachial plexus. Our anterior neck and pectorals tighten. Our neck flexes, putting pressure on the discs. Hours at a laptop and this is what happens.
My solution: a laptop stand, a separate keyboard and mouse, and a wrist cushion. That’s it.
I’m sharing these photos of me before I brushed my hair in the morning so you could see me in my natural work environment. Condolences to my wife.
Same thing goes for cell phones — try to keep them at eye level. Yes, you will look funny until this catches on. But your neck will thank you.
⚠️ Educational content, not medical advice. See your doctor if you’re experiencing numbness or pain.

02/19/2026

You spend a third of your life sleeping. Here’s how to stop wrecking your spine while you do it.
Back pain: sleep on your back (pillow under knees) or your side (pillow between knees). Not your stomach — it exaggerates the curves in your low back.
Neck pain: same rules. Back or side. If your pillow is pushing your neck up or down, it’s wrong for you.
And before you ask what the “perfect” pillow is — my wife and I actually tried to build one. Went through the research, got a prototype made, loved it ourselves. Sent it to family for testing. They called us asking why we were trying to torture them. Scrapped the whole thing.
Everyone’s different. Keep experimenting until you find what works for you.
⚠️ Educational content only, not medical advice. If you have significant neck or back pain, talk to your doctor or healthcare team about sleep positioning that’s right for your specific condition.

02/18/2026

“Isn’t spinal cord stimulation just masking the pain?”
I get this question all the time. The short answer: no. Your body still protects you — drop a bowling ball on your foot with a stimulator and you’ll absolutely feel it.
The key is understanding two types of pain. Nociceptive pain is your body’s alarm system — sharp, immediate, useful. We’d never want to turn that off. Neuropathic pain is different. The nerves themselves are malfunctioning — firing abnormally from old injuries, scar tissue, or chronic inflammation. The pain isn’t warning you about anything. It IS the problem.
Spinal cord stimulation treats neuropathic pain. It’s not masking the problem. It’s treating it.
⚠️ This is educational content, not medical advice. Spinal cord stimulation isn’t right for everyone. If you have chronic pain, talk to your doctor about whether you’re a candidate and what options are appropriate for your specific condition.