Dr. Kushagra Verma doesn’t just run a spine care practice—he leads it with intention, integrity, and data. In this episode, Dr. Verma lays out a clear blueprint for what leadership looks like in medicine. He shares how rejecting volume-based care in favor of concierge-level attention has allowed him to maintain high standards and build lasting trust with patients.

Craig Andrews explores Dr. Verma’s early pivot from engineering to surgery, his work in global outreach, and the leadership lessons learned while operating under extreme constraints. Dr. Verma explains how creating an evidence-based practice means blending data, experience, and patient preferences—never defaulting to one-size-fits-all decisions.

From his surgical philosophy to the way he builds patient relationships, Dr. Verma demonstrates that leadership in healthcare is about discipline, education, and consistency. This episode is a masterclass in doing hard things the right way.

Want to learn more about Dr. Kushagra Verma's work? Check out their website at https://www.advancedspinecare.com.

Connect with Dr. Kushagra Verma on LinkedIn at https://www.linkedin.com/in/kushagra-verma-99595714.

You can also follow him on Instagram at @asc.md. 

KEY POINTS WITH TIME STAMPS

• [01:16] Dr. Verma’s background and focus on minimally invasive spine surgery

• [02:55] The mission: Diagnosing root causes of back pain, not masking symptoms

• [04:00] Why engineering burned him out—and how it prepared him for surgery

• [08:11] Life-changing medical mission in Africa and how constraint shaped leadership

• [13:00] What “concierge care” really means in his independent practice

• [17:00] Why he rejected the high-volume model and prioritized patient relationships

• [20:09] Explaining evidence-based medicine through research, experience, and preferences

• [23:09] Why he only performs surgeries with 97%+ success rates

• [25:04] Practical advice for those with back pain: diagnosis, not guesswork

• [28:32] What to avoid to stay out of a spine surgeon’s office

• [30:00] How to reach Dr. Verma and where to find more educational content

Transcript

00;00;00;00 - 00;00;30;20
Craig Andrews
I was in a coma for six weeks while the doctors told my wife I was going to die. When I woke up, she told me the most fantastic story. My team kept running the business without me. Freelancers reached out to my team and said, we will do whatever it takes. As long as Craig's in the hospital. I consider that the greatest accomplishment in my career.

00;00;30;23 - 00;00;51;10
Craig Andrews
My name is Craig Andrews and this is the Leaders and Legacies podcast where we talk to leaders creating an impact beyond themselves. At the end of today's interview, I'll tell you how you can be the next leader featured on this show.

00;00;51;10 - 00;01;16;13
Craig Andrews
Today I want to welcome Dr. Kushagra Verma. He is the founder of Advanced Spine Care. It's a practice that's focused on providing high quality spine care for the community. His practice is both concierge and evidence based. And we're going to talk about what both of those things mean. I have a little confusion on one of those myself, but hopefully neither of us have confusion at the end.

00;01;16;16 - 00;01;17;06
Craig Andrews
And,

00;01;17;06 - 00;01;26;23
Craig Andrews
he's a spine surgeon that specializes in minimal, invasive and, complex spine surgery. Doctor Verma, welcome.

00;01;26;25 - 00;01;29;07
Dr. Kushagra Verma
Thank you for having me. I appreciate it.

00;01;29;10 - 00;01;34;00
Craig Andrews
Yeah. You know, it's it's so interesting.

00;01;34;00 - 00;01;49;19
Craig Andrews
You know, your your specialty. It it seems like there's so many people I keep running into, people that have some type of back issue, and it's it's debilitating. I mean, I have a family member that fits that case.

00;01;49;19 - 00;01;58;03
Craig Andrews
I used to have a lot of back pain, which, fortunately went one way naturally, but, let me just start by asking why?

00;01;58;09 - 00;02;03;01
Craig Andrews
Why do you think we have so much to make back issues in this country?

00;02;03;04 - 00;02;05;05
Dr. Kushagra Verma
Well, back pain is pretty complex.

00;02;05;05 - 00;02;11;12
Dr. Kushagra Verma
I think you can get back pain from the muscles. You can get it from maybe just being out of shape and carrying too much weight.

00;02;11;12 - 00;02;22;02
Dr. Kushagra Verma
Also, the spine is like a joint on top of a joint on top of the joint. And you have 33 bones in the spine. And so any of them can get arthritic down.

00;02;22;05 - 00;02;35;16
Dr. Kushagra Verma
A lot of times people have issues at the bottom two levels, and I would say everybody has some degree of arthritis and and probably pain from those bottom two levels. What what we sort of lack I think in, in spine,

00;02;35;16 - 00;02;54;29
Dr. Kushagra Verma
is that often we don't have a diagnosis. People have back pain. They see their general practitioner. They're maybe given some therapy or muscle relaxers or something like that, but never do they really get the full workup and know why they have pain, and what level is the problem, and have good imaging to sort of diagnose the problem.

00;02;55;01 - 00;03;01;16
Dr. Kushagra Verma
So that's sort of my mission when I see patients is, you know, really investigate it.

00;03;01;18 - 00;03;07;24
Craig Andrews
Yeah. Well very cool. Well, obviously we want to dig into that, but I also want to kind of go back.

00;03;07;24 - 00;03;18;16
Craig Andrews
I was looking over a little bit of your, your history, and it looks like you were always destined for medicine. You started off with a biomedical engineering degree.

00;03;18;18 - 00;03;41;14
Dr. Kushagra Verma
That's right. I actually didn't think I was going to go to med school. I thought I was going to be an engineer. Engineer? I was a tinkerer as a kid. I won that, and it wasn't necessarily the smartest kid in high school when it came to test. But, you know, I did a little science fair project at home as a freshman, and I won the entire state science fair, and everyone was like, that's really weird for a freshman in high school to do.

00;03;41;14 - 00;03;52;29
Dr. Kushagra Verma
And then I did it again as a senior. And so I definitely had like a engineering creative way of and a good presenter, probably to. And that got me into a pretty good,

00;03;52;29 - 00;03;54;18
Dr. Kushagra Verma
engineering school and

00;03;54;18 - 00;04;02;14
Dr. Kushagra Verma
into Cornell. And I thought that was it. I was going to do engineering, and I kind of got a couple years into it, and I was like, I really can't do this job.

00;04;02;14 - 00;04;22;21
Dr. Kushagra Verma
I can't sit behind a desk. I'm a people person. I want to be talking to people. And I think the turning point for me is I worked for a company that designed Total Artificial Hearts, which is so cool to me in concept, and I spent every day after work watching surgery videos in their library and being fascinated by surgery.

00;04;22;21 - 00;04;26;17
Dr. Kushagra Verma
And so I kind of pivoted away from engineering. Right?

00;04;26;17 - 00;04;28;09
Dr. Kushagra Verma
Right near the end of college.

00;04;28;11 - 00;04;37;23
Craig Andrews
Wow. Wow. And now biomedical engineering is kind of a broad area. Where were you? Was there one part of that that interested you more than others?

00;04;37;24 - 00;04;59;13
Dr. Kushagra Verma
Yeah, I was a little more mechanical engineer, and I like, shifted into being more in biomedical engineering. But I wasn't really that much of an engineer. I really was kind of sure, by the end of college, I wanted to go to med school, and I sort of was ready to leave engineering behind, like doing these like long problem sets, sitting there for hours and hours.

00;04;59;13 - 00;05;23;19
Dr. Kushagra Verma
It just, I, I didn't think I wanted to do that anymore. It's I mean, every Thursday night all the college kids are going to the bars and all the nerds and the engineering building are sitting there doing problem sets, because the problem sets were always do 8 a.m. Friday morning. So we were pulling all nighters trying to finish it, and I was so burned out I was like, I'm not doing that for the rest of my life, you know?

00;05;23;19 - 00;05;27;05
Craig Andrews
So I have I have an engineering actually a couple degrees and I,

00;05;27;05 - 00;05;44;28
Craig Andrews
I was taking an econ class with one of my buddies that was in engineering, and the professor said, all right, I have a homework assignment for you. And the whole class groaned, and he and I looked at each other and we started laughing because the longest homework assignment we had in the entire class was like 45 minutes.

00;05;45;00 - 00;05;49;19
Craig Andrews
And in engineering, that's like one problem. It's yeah, okay.

00;05;49;21 - 00;06;12;16
Dr. Kushagra Verma
Yeah, it's one problem. And I'm not actually, to be honest, very good at those problem sets. And at Cornell, everyone is from China or India and super smart. So I learned it. I learned how to make friends and form a team quickly. And we would work together in the library on Thursdays, and I would learn from them and they would learn from me, and we would get it done.

00;06;12;18 - 00;06;13;04
Dr. Kushagra Verma
But,

00;06;13;04 - 00;06;31;11
Dr. Kushagra Verma
it wasn't until med school that I actually got interested in orthopedics. I kind of thought I was going to do a high risk job for a while. I don't know why. I did research in obstetrics, and I thought it was cool. And then I saw my first spine surgery as like the last block of third year, which is like near the end of med school.

00;06;31;13 - 00;06;32;11
Dr. Kushagra Verma
And I just was like, right,

00;06;32;11 - 00;06;54;01
Dr. Kushagra Verma
guys, what I want to do, I want to put screws in the spine. This is the coolest surgery. And, you know, it was kind of it cool. It worked out the right way because there's a lot of engineering principles that go into spine surgery. You're trying to instrument the spine and think about all these mechanical considerations in helping a patient with their back pain.

00;06;54;01 - 00;07;03;27
Dr. Kushagra Verma
So I think it worked out really well for me that I was an engineer, but I think there was probably no chance that I would get an engineering job.

00;07;03;29 - 00;07;06;29
Craig Andrews
Well, I imagine you would have. I,

00;07;06;29 - 00;07;14;22
Craig Andrews
I paid my way partially through engineering school by designing amplifiers used for cardiac research at UNC

00;07;14;22 - 00;07;25;05
Craig Andrews
hospital. And I had some professor that's at NC state that figured out how to get NIH money by kind of hiring us out to do some of the,

00;07;25;05 - 00;07;30;00
Craig Andrews
the instrumental portion that the the docs needed over UMC and Duke.

00;07;30;02 - 00;07;31;18
Dr. Kushagra Verma
That sounds fun.

00;07;31;21 - 00;07;36;23
Craig Andrews
It was it was fascinating. And I mean, you learn a lot.

00;07;36;23 - 00;07;37;19
Craig Andrews
You know,

00;07;37;19 - 00;07;57;02
Craig Andrews
all the patients were animals, so they would do, like, open heart surgery on pigs and, you know, and of course, all the patients died because they had such a cocktail of drugs in them. By the end of the experiment. Yeah, yeah. You have doctors in their seat eating a ham sandwich while they're looking over this beating heart and.

00;07;57;05 - 00;08;02;24
Dr. Kushagra Verma
Sounds so normal.

00;08;02;27 - 00;08;04;15
Craig Andrews
So the,

00;08;04;15 - 00;08;11;05
Craig Andrews
that one thing you mentioned, you know, when you was this in your residency that you ended up going over to Africa?

00;08;11;08 - 00;08;18;17
Dr. Kushagra Verma
It was actually in medical school, so I got interested in spine. I was a little late to the game. I didn't have the best grades.

00;08;18;17 - 00;08;28;15
Dr. Kushagra Verma
Do you have to? Unfortunately, the way the med school system works is you got to crush these tests in order to get into the more competitive specialties. And I was never a test taker.

00;08;28;15 - 00;08;39;05
Dr. Kushagra Verma
Exceptional test taker was a little bit of a disadvantage. I wanted to do orthopedics and spine. And there's one surgeon, Professor Voce.

00;08;39;05 - 00;08;50;01
Dr. Kushagra Verma
I heard him give a talk on global outreach, and I was in 2008 or maybe early 2009. I basically ran up to him at the end of the meeting, and I was like, please take me with you.

00;08;50;01 - 00;09;12;25
Dr. Kushagra Verma
This is what I want to do. And he did. And he took me to Africa in Ghana at the I think it was the end of 2009 and I had such a great experience. You know, I got to watch really complex pediatric spine surgery being done in West Africa, which sounds crazy, but they really had it really dialed in and they just gradually made incremental improvements.

00;09;12;27 - 00;09;35;25
Dr. Kushagra Verma
You got to work with the local surgeons. It was a really good environment fostering like collaboration. Like really it was everything you want to be as a doctor in Africa. It was like, oh, this is why I'm I want to be a doctor. I want to do this kind of work. I want to be helping people in underserved areas and doing these complex cases.

00;09;35;28 - 00;09;42;13
Dr. Kushagra Verma
It really changed me. I was like, pretty much like, I'm going to do spine surgery. After that, I went to residency at,

00;09;42;13 - 00;09;56;11
Dr. Kushagra Verma
in Jefferson in Philly. Dr. Rothman Institute, and I kind of kept up my interest in outreach. I did research on outreach work. I even went back to Africa a couple of times as a resident. And at the end of fellowship.

00;09;56;13 - 00;09;57;06
Dr. Kushagra Verma
And then,

00;09;57;06 - 00;10;13;22
Dr. Kushagra Verma
I had the opportunity to work with other people. I went to Colombia, I went to Mexico, and then I've also gone back to Africa, which I always have a soft spot for, because it was the first place I went. And it's a really special thing that someone has given me.

00;10;13;22 - 00;10;18;00
Dr. Kushagra Verma
Is this like career interest?

00;10;18;02 - 00;10;24;28
Craig Andrews
Did it do you think that the environment forced more creativity?

00;10;24;28 - 00;10;33;20
Craig Andrews
You know, so generally I, you know, what I find is the more constraints we have or the more scarcity we have, the,

00;10;33;20 - 00;10;46;16
Craig Andrews
the more creative we become. And so in terms of what you saw in Africa, did you see because and maybe I have wrong thing because when I think about Africa, I think great, greatly impoverished, you know,

00;10;46;16 - 00;10;47;16
Craig Andrews
minimalistic,

00;10;47;16 - 00;10;50;12
Craig Andrews
medical facilities and all of that.

00;10;50;14 - 00;11;02;22
Craig Andrews
And so I'm wondering, one is, is that the case? Is that what you found? And then too, did that foster different types of problem solving that we might not naturally do here?

00;11;02;25 - 00;11;12;08
Dr. Kushagra Verma
Yeah, it's a really good question. I think it's a little bit of both the facilities they built a hospital, they're they're actually exceptional. The O.R. is great. Their protocols, everything is great.

00;11;12;08 - 00;11;13;00
Dr. Kushagra Verma
But the,

00;11;13;00 - 00;11;21;26
Dr. Kushagra Verma
they don't have all the fancy tools. They don't have a robot. They don't have, like, navigation. And so you are relying a bit more on visualization.

00;11;21;27 - 00;11;38;18
Dr. Kushagra Verma
Seeing the spine, seeing your landmarks, putting the screws in based off the wheel and things like that. And then in these cases, you don't have any landmarks like the spine sometimes is twisted completely in half like a pretzel. And you know, all your normal landmarks are disordered,

00;11;38;18 - 00;11;43;12
Dr. Kushagra Verma
you know, disturbed. And it's very disorienting. You're like, well, where's the spinal cord?

00;11;43;12 - 00;11;53;07
Dr. Kushagra Verma
Where is this a bone? Is this like, is this long? So from a surgical perspective, it's very challenging. It challenges your brain,

00;11;53;07 - 00;12;09;11
Dr. Kushagra Verma
to be better. And you don't, you know, any sort of advanced technology will help you in these cases. It just it wouldn't be helpful. You have to rely on instinct and palpating, a little piece of bone where you want to put in the screw.

00;12;09;15 - 00;12;13;05
Dr. Kushagra Verma
And so it makes it sharpens your skills. And the surgeon, for sure.

00;12;13;05 - 00;12;17;07
Dr. Kushagra Verma
But I wouldn't say the quality is any less than,

00;12;17;07 - 00;12;26;15
Dr. Kushagra Verma
You just have to be. I think, appropriate for that environment. You know, like, if you have a really huge curve,

00;12;26;15 - 00;12;36;24
Dr. Kushagra Verma
and you have to correct it, you're going to correct it, but maybe you're slightly less aggressive in an outreach setting than you would be at home where you had, you know, you know, the ICU person, you know everything.

00;12;36;27 - 00;12;43;15
Dr. Kushagra Verma
You have all the comforts of being in America. You'd maybe be a little bit less aggressive.

00;12;43;15 - 00;12;45;24
Dr. Kushagra Verma
But I think the quality is the same.

00;12;45;26 - 00;12;56;17
Craig Andrews
You know, now, there were a couple terms you used, and I will tell you, one of those terms has me completely confused. And that was concierge.

00;12;56;19 - 00;12;57;18
Dr. Kushagra Verma
Yeah.

00;12;57;20 - 00;13;11;16
Craig Andrews
And I thought I understood concierge. And then all the direct med guys told me, no, no, no, you know, I thought what they were doing was concierge. So first off, high level, what is concierge? And then how is that different than Drac med?

00;13;11;19 - 00;13;19;00
Dr. Kushagra Verma
We're seeing this trend, so I might, like, turn off. Let me turn it off. Okay.

00;13;19;03 - 00;13;20;12
Dr. Kushagra Verma
We're seeing this trend,

00;13;20;12 - 00;13;36;15
Dr. Kushagra Verma
for sure, in health care, where primary care is going, splitting into two tiers. Really? You have more concierge level care, and then a little bit less concierge. And what that means is, like, you can reach out to your doctor, you have their cell phone number.

00;13;36;15 - 00;13;46;05
Dr. Kushagra Verma
The doctor spends extra time with you and in primary care, they're often charging a fee for this extra service.

00;13;46;08 - 00;13;49;17
Dr. Kushagra Verma
In our practice, we don't really charge a fee.

00;13;49;17 - 00;14;04;13
Dr. Kushagra Verma
But I love the concept of taking care of people like they're your family member, that they have immediate access to the doctor, that they can call and text, that the patient that walks in the door feels extremely well cared for. I think that concept in health care should not die.

00;14;04;16 - 00;14;28;25
Dr. Kushagra Verma
It's a little bit old school. It's, you know, the way maybe your parents described going to see a doctor. They had like 45 minute visits and they could spend a lot of time with their doctor. We want that same experience. It's challenging to do a run, a practice like that. So one of the reasons I'm solo, I have an independent practice because we don't always have to follow all the rules of a big group.

00;14;29;02 - 00;14;47;08
Dr. Kushagra Verma
We can kind of choose to care for our patients the way we want. I think the patient experience is better, so if it's better for the patient and the doctors want it, why don't we all run our practices like that? So that that's what it means to me is, you know, I go above and beyond, people have there's my cell phone number.

00;14;47;08 - 00;14;51;17
Dr. Kushagra Verma
We spend a lot of time with people before and after surgery.

00;14;51;19 - 00;15;03;22
Craig Andrews
Well, I mean, and kind of evidence of that. Before we hit record, you gave me your cell phone number. I honestly, I think you're the first doctor that's ever given me a cell phone number.

00;15;03;24 - 00;15;13;26
Dr. Kushagra Verma
I mean, that's the way everyone has it now. Sometimes they'll reach out to me and they they'll be kind of disappointed that they'll be like, oh, doc, can you call on this prescription? And I'll say, please call the office.

00;15;13;26 - 00;15;25;01
Dr. Kushagra Verma
Yeah. Because I, you know, I'm in surgery or clinic or whatever, but it basically means that if there's an issue and it's an emergency, they can reach out to me, they can get to me, I can help,

00;15;25;01 - 00;15;34;23
Dr. Kushagra Verma
and I, you know, I was laying down to go to sleep last night, and I, before I went to bed, I was like, oh, I got to check on my patient that I operated on, and and that's

00;15;34;23 - 00;15;47;06
Dr. Kushagra Verma
just like a gut instinct that I have. I got a call. The nurse got to make sure he's doing okay is pain is okay overnight. And then I can go to bed and not worry. So I that's the way we've always practiced.

00;15;47;06 - 00;15;53;02
Dr. Kushagra Verma
It's how I was able to build a practice. And so I don't really intend on changing that.

00;15;53;05 - 00;15;57;22
Craig Andrews
And how would you describe the difference between what you do and direct med.

00;15;57;24 - 00;16;00;17
Dr. Kushagra Verma
What is direct med? Actually, I don't even know what that is.

00;16;00;20 - 00;16;22;02
Craig Andrews
Well, and I maybe this is some of my confusion. So I had originally heard of concierge about 20 years ago, a little more than 20 years ago. And then I saw people around Austin doing it. And the way now that's more for primary care where I see it. Yeah, basically, you pay a monthly subscription.

00;16;22;02 - 00;16;29;03
Craig Andrews
But you also have direct access to, you know, when you go in, you're not seeing the pay and a lot of the same claims you're making.

00;16;29;10 - 00;16;34;26
Craig Andrews
You know, it's not that you get five minutes with them and they're gone. You know, they stay a little bit longer.

00;16;34;26 - 00;16;37;05
Craig Andrews
They're reachable after hours.

00;16;37;05 - 00;16;39;19
Craig Andrews
I've even heard of some cases where,

00;16;39;19 - 00;16;47;07
Craig Andrews
they'll do a home visit, you know, if you're calling it some. And for whatever reason, it just makes most sense for them to come to your home.

00;16;47;09 - 00;16;52;10
Craig Andrews
They'll come to your home. Now, we don't have the traffic that LA has, so that's a lot easier to do.

00;16;52;10 - 00;16;53;06
Craig Andrews
Yeah.

00;16;53;08 - 00;17;09;28
Dr. Kushagra Verma
But it's the same idea. Yeah. You just don't do as many cases. I think there's a little bit of pressure from the insurance companies to run your fact, your office like a factory, you know, doing a high volume of cases. I kind of did that for a while. And I didn't like it, and I don't think it really works.

00;17;09;28 - 00;17;13;29
Dr. Kushagra Verma
And so now we just bring down the volume and,

00;17;13;29 - 00;17;27;09
Dr. Kushagra Verma
spend more time with people and, and do a better job, I think, I think that's really where I want, I want healthcare to be. I want to model my practice after what I think spine surgery should be. Yeah.

00;17;27;12 - 00;17;38;24
Craig Andrews
Yeah. And I, I mean, my personal belief is that the traditional insurance model is is not sustainable. I mean, the,

00;17;38;24 - 00;17;43;29
Craig Andrews
the rating, you know, double digit year on year rate increases. I just,

00;17;43;29 - 00;17;57;05
Craig Andrews
in a couple months, my, my insurance is going to bump up another 20%. Yeah. And, bumped up 20% last year. And I just don't think that's sustainable.

00;17;57;05 - 00;18;18;23
Craig Andrews
And then when you go to get care, you, you end up battling about what's covered and what's not covered and used to be. I mean, years ago, I'm on one of the pre ACA plans. That's a high deductible plan because my view is I want to use insurance for the catastrophic. So when I was in the hospital for three months it's exactly what I needed.

00;18;18;25 - 00;18;21;09
Craig Andrews
It was wonderful. We're not bankrupt.

00;18;21;09 - 00;18;37;26
Craig Andrews
Yeah. But you know, below the deductible. And except for three years in a row, I've never hit my deductible. And that gives me the freedom to go find if I decide I need something for my care, I just go get it.

00;18;37;28 - 00;18;41;07
Dr. Kushagra Verma
Yeah, yeah, that's that's what a lot of people are doing.

00;18;41;07 - 00;18;54;23
Dr. Kushagra Verma
We're seeing a lot of the same struggles around, like, they keep raising the rates on patients, but a lot of insurance companies want to pay Medicare rates, which Medicare has an increased what they pay doctors in like 30 or 40 years. Wow. You know,

00;18;54;23 - 00;19;02;21
Dr. Kushagra Verma
like my friend, had a had an emergency spine surgery on his dog and they needed to do a lamb and ectomy on the dog.

00;19;02;23 - 00;19;19;23
Dr. Kushagra Verma
And the veterinarian charged $13,000 for that surgery. Medicare pays $1,300 for that same surgery on a human. So you can you can just imagine that if all the insurances and Medicare are following these rates, it just doesn't work. You know, it's,

00;19;19;23 - 00;19;22;10
Dr. Kushagra Verma
it's it's a real challenge to,

00;19;22;10 - 00;19;27;01
Dr. Kushagra Verma
try to run a practice. A lot of times we're seeing things not get approved.

00;19;27;01 - 00;19;40;10
Dr. Kushagra Verma
Patients have to call file grievances. Still doesn't get approved. They're not getting approved for any good reason. They're just wanting to deny surgeries. Yeah. So we spend a lot of time fighting those battles.

00;19;40;10 - 00;19;48;14
Dr. Kushagra Verma
And we usually need our need our patients to help us, you know, call their insurance and things like that. That's the ugly side of health care.

00;19;48;14 - 00;19;57;14
Dr. Kushagra Verma
But I think if you have a good staff behind you and you're persistent, eventually you'll forget your surgery.

00;19;57;16 - 00;20;00;03
Craig Andrews
Yeah. The,

00;20;00;03 - 00;20;02;16
Craig Andrews
Yeah.

00;20;02;16 - 00;20;09;27
Craig Andrews
The other term that you used is evidence based medicine. And,

00;20;09;27 - 00;20;11;16
Craig Andrews
I know that's a term that's,

00;20;11;16 - 00;20;21;18
Craig Andrews
been around for a while, and my perception is most people don't know what that means. And those that do know what it means don't necessarily follow it.

00;20;21;20 - 00;20;48;29
Dr. Kushagra Verma
Yeah, well, spine's really tough. There's it's complicated cervical, thoracic, lumbar. And there's a lot of research in general. I think spine is moving in two directions with the one and two level problems and stuff most of us have are becoming more minimally invasive smaller incisions, smaller surgeries, outpatient, more disc replacement. That's definitely happening on the other side. The more complex stuff, we're doing that better.

00;20;49;01 - 00;20;58;26
Dr. Kushagra Verma
So we do have research that's being done. Some of the research is a little hard to interpret. Does this apply to my patient or not? But what I try to do is,

00;20;58;26 - 00;21;12;03
Dr. Kushagra Verma
use my academic background and also stay on top of what's being done and present that research to the patients. That's what I mean by evidence based is I give people a diagnosis, okay, this is the bad level.

00;21;12;03 - 00;21;32;06
Dr. Kushagra Verma
This is the issue. This is a diagnosis. These are the different ways to treat it. And here are the pieces of data that we have in terms of what the outcomes are long term. And then I usually go into it a little more and say but my opinion based off my personal experience is maybe this and that is better.

00;21;32;08 - 00;21;49;19
Dr. Kushagra Verma
And some of it's evidence based and some of it is what we call level five evidence, which means it's expert opinion. This is what I've seen as a surgeon for five years. This is what my friends are doing that are surgeons. This is a trend I've seen so that people have more than just, okay, doc, you're the doctor.

00;21;49;19 - 00;21;59;25
Dr. Kushagra Verma
I'll do the surgery. I want them to be involved in the decision making. I truly, I mean, I we made really big TVs in all the exam rooms so people can see their imaging.

00;21;59;25 - 00;22;12;06
Dr. Kushagra Verma
I, a lot of what we're doing is this kind of stuff during our consults, I'm really explaining to them the, the problem, showing them the models and also going over the literature.

00;22;12;06 - 00;22;34;04
Dr. Kushagra Verma
And then where we don't have literature, where's the controversy? A lot of times people can see 2 or 3 spine surgeons and get six opinions and I'll be like, well, what do I do here? And the truth is, you know, you kind of have to sometimes make your own decision about, do I do one level versus two open, minimally invasive things like that?

00;22;34;06 - 00;22;54;00
Craig Andrews
Well, and the way you just laid that out is my understanding of evidence based. It's you know, there's basically three main elements. There's an element of there's the research that's out there. Then there's the expertise of the doctor or the surgeon that you're dealing with. And then the third element of evidence based is patient preferences. You know, pulling the patient.

00;22;54;00 - 00;22;55;28
Craig Andrews
And and

00;22;55;28 - 00;22;58;07
Craig Andrews
and I,

00;22;58;07 - 00;23;08;29
Craig Andrews
in my own personal journey, I've heard people claim evidence based where they, they only follow one, one of those three things, they toss out the other two.

00;23;09;01 - 00;23;30;00
Dr. Kushagra Verma
Yeah. I mean, a a component of what I try to do is go to meetings and I like, get dinner with other spine surgeons and try to get their opinions on what's what's being done. That's different in general, as a general rule, I try to only operate in the 97% success rate, which means 9,798% of people that come in.

00;23;30;00 - 00;23;55;27
Dr. Kushagra Verma
If they choose to have surgery, they're happy with their outcome. Yeah. And, you know, that means we kind of reject all the surgeries that I don't think work. And so if if we don't have literature that supports greater than 90% success rate, I won't do that surgery. Yeah. That means certain surgeries like C fusions, I don't really do because the literature has been a little all over the place.

00;23;55;29 - 00;24;02;23
Dr. Kushagra Verma
Spinal cord stimulators. I don't really do that surgery. And sometimes I lose business because somebody else will do it.

00;24;02;23 - 00;24;15;17
Dr. Kushagra Verma
But I think it's better not to. I think I prefer and then some of the complex surgery we do, to be honest, if it's really big, complicated revision surgery, complication rate is quite high.

00;24;15;17 - 00;24;19;19
Dr. Kushagra Verma
It's often a small complication, but it can be a wound infection and readmission.

00;24;19;19 - 00;24;45;21
Dr. Kushagra Verma
It can be a small medical issue that that numbers over 50%. And so I have conversations with people that are thinking about complex spine surgery and for their, you know, grandmother, that's 70. I'll have these conversations and discuss the evidence. Hey, the complication rates are really high. And so we only do those types of surgeries when someone is truly disabled in severe pain, can't walk.

00;24;45;23 - 00;24;53;22
Dr. Kushagra Verma
But I think patients have a right to know what the data is sort of saying and what's new and what's out there.

00;24;53;24 - 00;25;04;03
Craig Andrews
Yeah. So let me ask you this. There's obviously a lot of people there struggling with back pain. I mentioned somebody I know in my,

00;25;04;03 - 00;25;07;03
Craig Andrews
family who's struggling with it.

00;25;07;03 - 00;25;18;27
Craig Andrews
For somebody that just has chronic back pain, would it. Yeah. And as much as you could give generic advice in this forum, what would you advise they do?

00;25;18;29 - 00;25;21;20
Dr. Kushagra Verma
No, that's a great question because I get it all the time.

00;25;21;20 - 00;25;35;27
Dr. Kushagra Verma
If you had chest pain, you'd really want a cardiologist to get an EKG, chest X-ray, maybe a stress test to figure it out. What? I see a lot of my specialty is people have back pain. Maybe they go to therapy, maybe it gets better, maybe it doesn't.

00;25;36;00 - 00;25;53;06
Dr. Kushagra Verma
They've never gotten a diagnosis. So I'm a big proponent on everyone. Should get a good set of X-rays, get an MRI and see a spine surgeon. 95% of the people I see don't need surgery. At least right away, but it's important that they have a diagnosis. Is there,

00;25;53;06 - 00;25;57;28
Dr. Kushagra Verma
really one really bad level? Is it spinal stenosis? Is a nerve pinched?

00;25;58;00 - 00;26;08;00
Dr. Kushagra Verma
Is it a spondylolisthesis where the bones slipped out of place? There's lots of different things that could be going on that can cause back pain. And I think going down the rabbit hole,

00;26;08;00 - 00;26;21;04
Dr. Kushagra Verma
couple of visits with a spine surgeon is very valuable. After you've done all that, you want to do all the non-surgical stuff before you ever think about surgery, which is physical therapy, core strengthening,

00;26;21;04 - 00;26;22;06
Dr. Kushagra Verma
weight loss.

00;26;22;09 - 00;26;40;17
Dr. Kushagra Verma
If people are carrying extra 30 or 40 pounds, especially around their midsection, and they have a weak core, they're going to have back pain. If they have a job where they're doing a lot of repetitive, heavy lifting, it's going to put a lot of strain on the back. If they have a bad level and they're doing heavy lifting from the floor, it's going to aggravate it.

00;26;40;20 - 00;26;49;13
Dr. Kushagra Verma
So I think a combination of strengthening your core weight loss and getting a good diagnosis is is probably the most important thing.

00;26;49;16 - 00;27;09;17
Craig Andrews
Yeah. And you know, it's it's interesting I mentioned to you, I think in the green room that I go to something called Camp Gladiator. I used to have to go to get therapeutic massages on a regular basis. And I told my wife the other day, I said, you know, since I've been going to Camp Gladiator, I haven't really need a massage.

00;27;09;19 - 00;27;16;04
Craig Andrews
And they start every workout with a series of stretches. They usually start stretching and end stretching.

00;27;16;06 - 00;27;18;10
Dr. Kushagra Verma
I think it's super valuable.

00;27;18;10 - 00;27;31;11
Dr. Kushagra Verma
I strength train myself five days a week because, I mean, I see I'm always looking into the future. I know what it looks like if you're 70 and you don't take care of yourself and you've got extra weight and you've lost a lot of muscle,

00;27;31;11 - 00;27;35;05
Dr. Kushagra Verma
but the other part of this that we don't really know is the value of stretching.

00;27;35;07 - 00;27;45;05
Dr. Kushagra Verma
And there's like stretch labs that have opened up in different places around my town. And I think there's a lot of value to keeping your joints mobile, stretching.

00;27;45;05 - 00;28;00;03
Dr. Kushagra Verma
There's even data that just stretching alone helps build muscle. Forget about strength training. Just stretching the muscles stimulates muscle growth. So that could be a great thing. Everybody does. I mean, my wife does yoga and I was always like, this isn't a real workout.

00;28;00;03 - 00;28;11;08
Dr. Kushagra Verma
What are you doing? Sure enough, I mean, you've been doing yoga at six months, 2 or 3 days a week. It's gotten very strong and it's like 5 pound weights and holding funny positions. But,

00;28;11;08 - 00;28;13;20
Dr. Kushagra Verma
I think there's a lot of value to stretching. And,

00;28;13;20 - 00;28;20;07
Dr. Kushagra Verma
you don't have to necessarily strength train to have a strong physique and build muscle.

00;28;20;09 - 00;28;32;25
Craig Andrews
Yeah. So let's wrap up with this. What advice would you give to folks so that they never need to walk through the door of your office?

00;28;32;28 - 00;28;57;24
Dr. Kushagra Verma
Well, I would say don't be afraid to walk in the door, because most of the time we're not telling people they need surgery. And that information is super valuable to know what's going on, because everybody has back pain. And it would be helpful to know, is it one bad level? Is it two bad levels? Is it? I think that knowledge isn't something we should be afraid of.

00;28;57;26 - 00;29;03;27
Dr. Kushagra Verma
The other thing is, I think having a strong core, staying lean,

00;29;03;27 - 00;29;15;11
Dr. Kushagra Verma
are really good ways to avoid back pain and the types of activities that I think really seem to trigger back pain is really heavy deadlifts and like,

00;29;15;11 - 00;29;21;09
Dr. Kushagra Verma
really heavy squats, because a lot of times people have a disc problem, right. The disc is a little worn out.

00;29;21;11 - 00;29;38;17
Dr. Kushagra Verma
You're doing really heavy squats. You're loading that disc and you can trigger back pain, disc genic type back pain. And if you're doing deadlifts where you're bending over with the weight, if you've got a level that's a little unstable and it's slipping out of place, then bending over is going to aggravate that type of pain.

00;29;38;17 - 00;29;50;05
Dr. Kushagra Verma
So those are the two activities I tell people, and I do squats and deadlifts every week, but if I had back pain, I would back off of those activities and I would get an x ray and an MRI and try to figure it out.

00;29;50;08 - 00;29;52;09
Dr. Kushagra Verma
Why am I getting that pain?

00;29;52;12 - 00;29;56;15
Craig Andrews
Yeah. Well, Doctor Verma, this has been very interesting.

00;29;56;15 - 00;29;59;04
Craig Andrews
How can folks reach you?

00;29;59;07 - 00;30;10;08
Dr. Kushagra Verma
They can reach us by calling our office number 562732 4 or 5 seven eight. We're also on Instagram and Advanced spine Care as TMD.

00;30;10;08 - 00;30;27;07
Dr. Kushagra Verma
They can also follow me on Instagram. Kush Agra, Burma, MD is a little bit of a mouthful. Kush Agra. But that's why we made a practice Instagram to Akhmed. We like to post a lot of educational content there.

00;30;27;09 - 00;30;37;12
Dr. Kushagra Verma
We also have a website, Advanced Spine Caricom and if you're anywhere in Southern California, I'm happy to see you and hopefully give you good information.

00;30;37;15 - 00;30;40;19
Craig Andrews
Well, excellent. Well, thanks for sharing that and leaders and legacies.

00;30;40;21 - 00;30;43;29
Dr. Kushagra Verma
I appreciate it. Thank you so much.

00;30;43;29 - 00;31;10;25
Craig Andrews
This is Craig Andrews. I want to thank you for listening to the Leaders and Legacies podcast. We're looking for leaders to share how they're making the impact beyond themselves. If that's you, please go to Ally's for me.com/guest and sign up there. If you got something out of this interview, we would love you to share this

00;31;10;25 - 00;31;12;20
Craig Andrews
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00;31;12;22 - 00;31;36;02
Craig Andrews
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00;31;36;04 - 00;31;44;09
Craig Andrews
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00;31;44;09 - 00;33;46;14
Craig Andrews
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