Why Your MRI Might Be Lying About Your Pain

What if spine surgery isn’t the breakthrough… but the backup plan?

In this episode, we sit down with a neurosurgeon who spent years inside the spine—then stepped back, looked at the system, and quietly asked the question most patients never hear: “Are we treating the patient… or just treating the MRI?”

Meet Dr. Jeff Gross: “The Recovering Neurosurgeon”

Dr. Jeff Gross is a spine fellowship–trained neurosurgeon known for pushing medicine beyond the scalpel—into regenerative spine care, exosomes, peptides, and high-precision non-surgical approaches. He’s not anti-surgery. He’s anti-default surgery.

In his own words, he became the “non-surgical surgeon”—the guy whose colleagues bragged about doing 350 cases a year… while he celebrated doing less than 50. Because for him, the real flex wasn’t volume. It was judgment.

And the moment that changed everything wasn’t one dramatic failure—it was something worse: the slow realization that spine care wasn’t evolving the way it should. Conference after conference. Study after study. Same hardware. Same playbook. Decades old.

And that’s where the tension begins… because if the system isn’t built for nuance, who pays the price?

Dr. Gross explains why “modern” spine surgery still traces back to ideas from the 1940s—and what that means for your options.


What You’ll Learn

• Why non-surgical spine care is often the most advanced form of spine care

• How MRI findings can be unrelated to pain—and what to do instead

• The difference between stem cells vs exosomes (and why “messaging” matters more than “cells”)

• Why facet joint pain and SI joint pain are commonly missed

• How “shotgun” injections and ablation can create downstream problems

• Why Dr. Gross starts with lifestyle readiness before regenerative medicine

• How to measure progress with HRV, inflammatory markers, and biological age tests
   

The MRI Trap: When Imaging Becomes the Diagnosis

Here’s the uncomfortable truth Dr. Gross keeps seeing: many patients don’t get a diagnosis… they get an MRI interpretation.

In a rushed, institutionalized sick-care model, the story is almost predictable:

• Five minutes with a specialist

• MRI on the screen

• Minimal hands-on exam

• A plan based on the picture—not the person
   

Dr. Gross calls it out: sometimes what you see on imaging has nothing to do with the pain. A small disc protrusion can be incidental. A meniscal tear might not be the pain source. You can “fix” a finding and still not fix the patient.

He shares examples that are painfully common:

• Knee pain blamed on a meniscus tear when it’s actually patellofemoral pain

• Surgery done for the wrong target because the pain generator was never isolated
   

The principle is simple but rare: clinical correlation. Symptoms first. Exam matters. Then imaging supports—not dictates.

Finding the Real Pain Generator: Facet vs Disc vs “Everything”

One of the most valuable threads in this conversation is how Dr. Gross approaches complexity without guessing.

When patients arrive after multiple interventions—cortisone, facet blocks, epidurals, ablations—he doesn’t immediately “override” what’s been done. He audits it.

He asks:

• Where was the injection placed?

• Was it strategic (to confirm a pain generator) or a shotgun blast to quiet symptoms?
   

Because if a patient got temporary, dramatic relief from a precise block, that’s data. That’s a clue. That points to facetogenic pain rather than discogenic pain (or vice versa).

And he doesn’t sugarcoat the reality: pain is often multifactorial—disc, facet, ligament, muscle, nervous system amplification, rebound pain after meds. It’s an art.

But the solution is still systematic:

1. Identify the generator

2. Reduce inflammation and instability

3. Choose the least invasive path that actually addresses the mechanism
    

Ablation sounds like a shortcut… until you hear what it can do to the posterior chain over time.

Regenerative Spine Care: Biology Over Hardware

Dr. Gross doesn’t pitch regenerative medicine as magic. He frames it as signal + environment.

The regenerative ladder

• PRP (platelet-rich plasma): a foundational option using your own blood to amplify a healing response

• Stem cells (from bone marrow, fat, or donated tissues): historically the headline—but not always the “business end”

• Exosomes / growth factors / secretome: the message-delivery system that signals tissue repair pathways

• Peptides: small proteins that can influence recovery, inflammation, and cellular signaling
   

A key concept he emphasizes: cells communicate. This isn’t woo—it’s biology. Cells “talk” to neighbors through peptides and extracellular vesicles (exosomes). That conversation can shift local tissue behavior.

And when it comes to spine care, he gets specific about where biology matters:

He targets inflammatory changes like Modic changes (inflammatory bone edge changes) and subchondral bone edema—because if the bone environment is inflamed, cartilage-producing cells can’t do their job.

He also makes a strong point: regenerative care shouldn’t be offered into a hostile internal environment. He starts with:

• sleep

• movement

• diet and nutrition

• labs and imaging at a high level (e.g., advanced MRI sequences)
   

Because the goal isn’t to “inject hope.” It’s to create the conditions where the body can respond.

Dr. Gross explains why he often prefers exosomes over stem cells—and why “cutting out the middleman” matters now.

Myths vs Truth

• Myth: “If my MRI shows a disc herniation, that’s the pain.”
  Truth: Imaging findings often need clinical correlation—symptoms and exam still matter.

• Myth: “More injections = better plan.”
  Truth: Strategic diagnostic injections can be useful; shotgun approaches can confuse the case.

• Myth: “Ablation is a clean long-term fix.”
  Truth: Denervation can affect paraspinal muscles and the posterior chain; degeneration can accelerate.

• Myth: “Regenerative medicine is made up.”
  Truth: Dr. Gross emphasizes using science-based approaches—often supported by literature from Europe and Asia.

• Myth: “Walking is enough for longevity.”
  Truth: Walking helps, but strength + load matters for muscle, bone, and long-term resilience.
   

The most controversial “longevity lever” Dr. Gross uses isn’t surgery or even biologics—it’s how you build muscle.

Try This Today

• If you have chronic pain, ask: “Are we treating the patient or the MRI?”

• Track patterns: what worsens pain—sitting, stairs, bending, rotation, mornings?

• Build your “longevity organ”: strength train (progressive, weight-bearing) 2–4x/week

• Prioritize posterior chain work: hips, glutes, hamstrings, back extensors (smartly programmed)

• Consider tracking HRV trends (not single-day panic) using a wearable if you already own one

• If injections are suggested, ask whether they’re diagnostic and precise or just symptom suppression

• Make “movement breaks” non-negotiable if you sit for work
   

Dr. Gross shares why muscle isn’t just for looks—it’s endocrine, immune, and longevity signaling.

Why This Conversation Matters Now

Because spine care is at a crossroads.

On one side: a high-volume system that can reward speed, transactions, and imaging-first decision-making—where patients can be rushed toward interventions without a full story.

On the other: a growing movement toward precision diagnosis, regenerative medicine, and longevity-first thinking—where the goal isn’t simply “less pain,” but a healthier tissue environment, better movement capacity, and fewer irreversible procedures.

Dr. Gross doesn’t claim surgery disappears. He says it becomes what it should have always been: the right tool, for the right case, at the right time.

And that shift—back to exam, nuance, inflammation targets, muscle as medicine—is not a trend. It’s a correction.

5 Key Insights From This Episode

1. Most spine surgery hasn’t fundamentally changed in decades.
   Smaller incisions, new widgets—often the same decompression/fusion logic.

2. MRI findings can be incidental.
   Pain is clinical. Imaging is supportive—not definitive.

3. Facet joints and SI joint pain are underdiagnosed pain generators.
   Many “failed surgeries” were never targeting the correct source.

4. Regenerative medicine is signaling + environment.
   Exosomes, growth factors, peptides—tools to nudge repair pathways when lifestyle readiness is in place.

5. Muscle is the longevity organ.
   Strength training supports movement, bone density, and recovery signaling (myokines).
    

Imagine being told surgery is the answer—while the real cause of your pain was never even tested.

This episode isn’t hype. It’s a spine surgeon pulling back the curtain on what’s outdated, what’s misunderstood, and what’s finally evolving in non-surgical spine care.

You’ll hear the nuance that doesn’t fit into a five-minute consult—and the hope that comes from getting the diagnosis right.

For the full story and unfiltered conversation, listen/watch the Crackin’ Backs Podcast.
[Listen on Apple/Spotify link]
[Watch on YouTube link