It was more than 13 years ago that a veterinarian introduced Dr. Gregory Lutz to platelet-rich plasma (PRP). Dr. Lutz had a lame horse suffering from a tendon injury. With the help of a portable ultrasound, the veterinary physician drew the horse's blood, spun it in a centrifuge, and injected it into the tendon, right there in the stall. Within a few weeks, the horse was running around like a pony. That inspired Dr. Lutz to research this treatment for his own patients. 

With more than 30 years of clinical experience under his belt, Dr. Lutz has proven himself to be a driving force in today’s regenerative medicine movement. He has co-authored more than 60 scientific publications on the topic of PRP and continues to research the power of this treatment to improve outcomes.

“We have to share research, speak openly about our findings, report the good and the bad and the ugly, so that people are aware of the risks, and see if we can keep moving this forward,” says Dr. Lutz. “It's been a very exciting journey to finally find something that I think has staying power.” 

In this episode of Back Talk Doc, host Dr. Sanjiv Lakhia and Dr. Lutz discuss PRP treatments for low back pain and Dr. Lutz’s new book.

💡 Featured Expert 💡

Name: Gregory Lutz, MD

What he does: Dr. Lutz is the founder of the Regenerative SportsCare Institute, Physiatrist-in-Chief Emeritus at New York City's Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Nationally known for his work and writing on platelet-rich plasma treatments for disc injuries, Dr. Lutz just authored a new book, Heal Your Disc, End Your Pain: How Regenerative Medicine Can Save Your Spine.

Company: Regenerative SportsCare Institute

Words of wisdom: “There's some merit to that thought that if we intervene early with a structured healing treatment, you might prevent some of the degenerative changes that occur with the spine that most likely would result in more aggressive treatment like surgery.”

Connect: Website | LinkedIn

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Welcome. You are listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where cutting edge, nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice.

Now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

Welcome back listeners to another episode of Back Talk Doc. I am delighted to be recording our 60th episode. This was a project I started just a few years ago, and it's just really grown. I appreciate all the positive feedback, and if you've enjoyed the podcast, feel free to go on iTunes and leave us a five star review. Even more importantly than that, share an episode with a friend or family member that may be suffering with back pain.

Today, we're going to circle back to a topic that I covered last summer with my then partner, Dr. Peter Bailey. That is the concept of regenerative medicine in spine care. I'm very delighted to bring on one of the national thought leaders in the field and really going to pick his brain and discuss his new book. This is Dr. Greg Lutz. Greg, welcome to the show.

Thanks for having me. It's a pleasure to be here today.

Okay, let me introduce you to everyone. Greg is really well known in the physiatry circles nationally for the literature that he's published on platelet-rich plasma treatments for disco injuries. Greg is a founder of the Regenerative Sports Care Institute. He's physiatrist and chief emeritus at the Hospital for Special Surgery, and a professor of clinical rehabilitative medicine at Well Medical College of Cornell University. He's a pioneer in regenerative orthopedic medicine, and Dr. Lutz has co-authored more than 60 scientific publications, including the first double blind randomized controlled study, demonstrating the clinical efficacy of intra discos platelet-rich plasma therapy. That means that was a very high quality study, folks. He's a board member of the Interventional Orthobiologics Foundation, and the co-founder and executive chairman of Orthodon Corporation, and he is a author and is about to release his new book, Heal Your Disc, End Your Pain, How Regenerative Medicine Can Save Your Spine. You said that's coming out this week?

February 7th, yes.

Awesome. I was fortunate to get an advanced copy and I was able to read through it, and I really like it. It's put together in a way where people can understand it, and it really goes through some of your journey about how you came to the point where you're offering this exciting treatment for people.

Let's get started here. Why don't you walk listeners through kind of your career journey, where you almost, reading your book is almost like you stumbled into this path of being an advocate for Intradiscal PRP.

Yeah, and it's very interesting because really, the aha moment didn't really come in my medical practice. We have a farm, Hopewell, New Jersey, and had some horses and veterinary physicians that were taking care of our horses that introduced me to PRP. This was probably about 13 years ago. We had a horse that was lame from a tendon injury, and he drew the horse's blood, spun it in a centrifuge, injected into the tendon, right in the stall and their ultrasound. Then within a few weeks, the horse that was lame for months was running around like a pony.

Dr. Dan Keenan was the one who introduced me to this and he said, "You should be doing this on your patients in New York". I said, "I think you're right." When I looked into what PRP was, it really resonated. Platelet-rich plasma is really just taking a high concentration of your own innate healing cells and proteins, and then putting them into areas where tissue is damaged to promote healing. There's definitely a ceiling to the healing of structures like tendons and cartilage and discs that have poor blood supply.

Your skin heals very well, but those structures, because of the lack of blood flow in getting the right cells to the area, the healing is very slow or incomplete. That's really where it all started.

You do a nice job in your book outlining some of the struggles we have in medicine, dealing with low back pain in this country, whether it's the cost or even just the current standards of care. What about that kind of compelled you to look for a new answer?

Yeah. Most of the current treatments for patients with chronic lower back pain are really palliative treatments. What I mean by that, they don't really get to the root cause. When we first started using PRP, it was with tendon issues, like partially torn tendons. The very first patient that I ever did a procedure on with PRP was a 70 year old tennis player who had a really bad achilles tendon tear, and was walking around in a cam walker for months, trying to find some non-surgical treatment because he had a heart condition and he didn't want surgery.

When he came in my office, it was actually the first day I got my PRP kit and centrifuge. He was a hedge fund manager, and so he had invested in a PRP company, so he is really familiar with the science and the technology. I was looking for my first patient, but I didn't think it would actually treat a really bad achilles tear. We said risks were low. We proceeded and he was game, which was nice. Within a few weeks, he came back, he had a no pain. I injected him a second time, probably about a few months afterwards, and then he came back and he was already playing tennis on the second time he saw me.

I felt that that was too soon. I said, "Let's get an MRI to make sure that it's okay for you to go back." When I got the MRI, the tendon had completely healed normally, and that was the first time in my decades of clinical practice that I actually saw an achilles tendon tear of that size heel. That was my aha moment. Then it wasn't a big leap to go into the disc, because the same collagen that makes up the outer rings of the discs make up the tendons. We had been searching for something for patients, because on the conservative side, it's great to promote physical therapy and core strengthening, introduce the use of oral medications and occasional epidural steroid injection to put the fire out.

Even with those treatments, patients didn't always get sustained improvement. Then they were kind of left between living with the pain or going for a very risky, unpredictable spinal fusion surgery. It was nice to say, "Okay, well, maybe we have something to offer patients." Being at hospital for special surgery, doing a new novel treatment like that really required us to do it under an IRB. We said, really set up nicely for a double blind study, because you would do a test called a discogram, which is where we inject dye into a disc, and see if that disc has tears that are painful, that we would put more contrast in as a control group, or we would put the PRP in, then we would follow the patients.

Lo and behold, we saw a really meaningful difference in the patients that received the PRP. That PRP was really first out of box, which what I mean by that is that it was a lower concentration PRP, maybe three to five times your baseline platelet count, but now we're injecting 20 times and the results are better. I think that what's evolved as something really simple has the potential to be a very scalable treatment for, like you said, the number one cause of disability, not just in the US, but in the world. I'm very excited to share the message.

It's really makes me smile. You were looking at PRP, and then you have a patient who is familiar with PRP as a hedge fund manager. The odds of that are really pretty low. It's like Matthew McConaughey's book, Green Lights, that was a green light for you, I think.

Then the other thing that happened, which was a green light was when we wanted to do this double blind study. As you can imagine, it costs a lot of money. You can't charge a patient for a new treatment that you don't know if it works, but you want to do it in a very controlled, safe environment. If we did a study of 50 patients and each patient was 10,000 a pop to do the study, then you would need a half million dollars to do the study.

None of the PRP companies had really much money and were willing to give funding. Just as I was looking for money, one of my patients called me and he asked me to lunch. This is what happened. He said, "I want to give you a half a million dollars for research." He didn't know what I was researching. He just felt like, I want to help you in your studies, and that money is what funded the first double blind study.

It was like the hedge fund guy coming in, and having a miraculous result, and then another patient saying, "I want to give you money for a study." It's been a very interesting journey, and I think that's called, I think, synchronicity or fate. I don't know.

Okay. I want to get into, you covered a lot already even talking about some of why PRP could help and the anatomy of the disc, but again, for those people who are new and don't know much about the anatomy of the disc and why this could be an option, just briefly give a high level overview about why you think when we get some of these micro tears in our disc, why number one, they are sources of pain, and then number two, how the PRP can work towards helping them heal.

If you think of the disc, you could think of it as like a radial tire with the gelatinous core. There's about 20 circular fiber springs which contain that central gelatinous core, so that when your spine moves, all those hoop stresses are contained. What happens with aging, injury, smoking, obesity, sitting prolonged periods, is that some of those rings begin to develop micro tears. Those tears can propagate and lead to worse problems in the future.

Those tears really represent the onset of back pain for most patients. The problem is that when those tears begin, the internal anatomy of the disc is such that the blood supply is only on the periphery, and there's very low cell counts inside the disc. The healing is partial or incomplete at best. Then as that tear propagates, then the jelly can start to protrude. If it extrudes or becomes a sequestered fragment, then that's when you develop a leg pain and often a neurologic injury. The concept of PRP is very simple.

All we're doing is taking your platelets and white blood cells out of your blood. We'll take typically maybe 80 milliliters of your blood, and we spin it down to two or three teaspoons. We're effectively concentrating your platelets and white blood cells to very high levels, and just under X-ray guidance, injecting them right directly into the tears inside those discs to stimulate that natural healing. It's usually a four to eight week process for patients to feel substantial improvement.

You talk about in your book somewhat of a new concept, at least for me, I've been doing PRP, but more for orthopedic issues for a couple of years. What really caught my attention in your book was this idea of a microbiome in the disc itself. With my integrative medicine background, and my understanding of how significant a healthy gut microbiome is to the rest of the body, and the literature correlation between that and autoimmune disease and joint pain and things like that, I myself have always wondered and tried to do a little research about, is there a correlation between the microbiome and disc disease?

For example, why would I see, this week, even an 18-year-old girl come in with two dark discs on an MRI, and one with a high intensity zone bright white spot anular tear on her MRI and she's 18 years old? It's like, why is that happening? It just hasn't set with me this idea of it's just genetic. For me, I feel like we just don't understand it. What you wrote about, it's almost like a light bulb's going on. Can you discuss that a little bit to people, this idea of the microbiome that you talk about in your book, and its significance in terms of why disc injuries don't necessarily heal as well as they should?

This is really something that is only recent knowledge to myself over the past few years. The concept that I was taught was that the disc was a sterile environment, and that's completely wrong. There are studies now that show that even a normal disc has over 50 different species of bacteria. The concept that the intradiscal dysbiosis, which is an abnormal overgrowth of certain types of bacteria, leads to inflammation, and then further degeneration of that disc. What we see is, and you're familiar with this, is these bony endplate changes in patients, called modic type one endplate changes on the MRI.

When they biopsy those, the culture rates are very high, and many of them are from bacteria that is really ubiquitous in our bodies, called cutibacterium acne, which is the same bacteria that causes acne. It's a gram positive anaerobe, and it really likes an environment that has low oxygen, which is the disc. One concept is that when the disc tears and the body tries to heal and it sends some vessels into that tear, it brings that bacteria that then flourishes inside that environment, similar to a hair follicle. That's what causes some discs to be super painful and other discs not so painful.

I don't think it happens in every patient, but I think it happens in 30 to 40% of discs that we see with modic changes. What's so interesting with this treatment is that I really do believe we're killing two birds with one stone. We're putting in very high concentrations of platelets, which stimulates cells to come to the area and repair, but we're also putting in very high concentrations of white blood cells, which I think may be treating the overgrowth of bad bacteria. That's why I think this is such a scalable, simple, safe treatment for such a complex problem.

I have seen even the modic changes improve after our intradiscal leukocyte-rich PRP, which is really remarkable. You don't normally see that. That also correlates with those HIZs going away and the disc looking healthier. When you look at intradiscal leukocyte rich PRP, it really is a root cause treatment. We're treating collagen to heal and we're treating the microbiome inside the disc to be more healthy. I do believe that's what's happening.

I think it's just an amazing way to connect the dots. For me, I've made a note to go into that literature and learn more about it. I get lots of ideas brewing, at least from a holistic perspective. You can't have patience. I know there are some clinical trials, or at least some reports that came out years ago, where they talked about chronic low back pain improving with antibiotics. Some of that was refuted, but still, it's thought provoking.

You certainly cannot have people on antibiotics for a hundred days at a time to help their back pain, because just a lot of collateral damage with that. I wonder in the future, as we research things in terms of accessibility, can people be on some natural botanicals long term? Are there things we can do to shore up the disc microbiome holistically, and support some of the intradiscal PRP work? Anyway, I just thought I really wanted to bring that up. I just thought it's new. It's a concept not a lot of people have heard about, including myself. I look forward to seeing how that evolves over time.

From your angle, you're saying it really helps you decipher the type of PRP that works best, and that's a leukocyte rich PRP. For people, again, who don't understand the fancy terms, we're talking about platelet rich plasma with immune cells that can also help, as he said, kill two birds with one stone. I just think that was a very interesting part of the book.

We kind of fell into that, because when we did the first study, we had a decision to make whether we use leukocyte rich or leukocyte poor. The only reason we used leukocyte rich was just for the concept of infection risk, just mitigating against infection, not realizing that it may be what's really treating some of these discs is putting in 50 to 100 million white blood cells, which is mind blowing you fall into these discoveries and we're so concentrated on platelets, but it may actually be the white blood cells that are doing a lot of this healing.

I think what's really interesting is that the intradiscal microbiome is real. Like you said, those studies of putting people on oral antibiotics, it's not something you want to do, and that's not good antibiotic stewardship. There's 580 million people in the world with chronic lower back pain. Putting them on oral antibiotics for 100 days would not be the best strategy, and I think could lead to super resistant organisms. I think this is a much simpler, more elegant way of treating that.

Okay. Let me play some devil's advocate, because as you and I both know, there is some skepticism in the medical community about regenerative medicine. I think that's diminishing as more research becomes available, but there's one that I think comes to my mind that I'd love to get your feedback on. When we look at people and their MRIs, let's say, in a age group of 50 and above, there certainly is a percentage of them who have these tears on their MRI and their discs. It's debatable how clinically relevant those are.

I want to hear your thoughts on how do we determine, or at least, how do you determine when a patient comes in to see you, and you put up an MRI, and you've got three discs that have signs of tears? Are you looking at distinguishing MRI characteristics? Are you looking at history and exam? What are your thoughts on the idea that not every degenerative disc is a source of pain?

This is a very good point. First of all, right now, we only treat people that are in moderate to severe pain. When they come in, most of the patients we've seen have tried a multitude of treatments, whether it's oral medication, physical therapy, acupuncture, chiropractic care, and they're really in this decision making process of whether or not to go for aggressive spine surgery. At that point, we always start with a really good history and try to decipher what could be discogenic pain, which tends to be more sitting types of pain associated with morning stiffness.

Sometimes, it involves some radiation into the legs if there's a herniation. Then we often have to do, after we do our imaging studies to see, is it more than one level? Is it associated with other spinal issues? We do a diagnostic injection. We just do an epidural and we see if their pain goes away even temporarily. Once we hone in on the diagnosis, then we're going to go ahead and treat it with the intradiscal PRP to get more long-lasting relief. That process does take some time, and sometimes it's very clear cut.

When the pain starts radiating down the leg in a predictable nerve pathway, and the MRI looks abnormal at that level and it's a single level, that's an easier patient. One thing we've also learned is that if we intervene early, because we've been doing these procedures now for 12 years, I do believe we're stopping some of that degenerative process. I've seen many patients that we've treated without intradiscal biologics deteriorate over my three decades of clinical practice.

I'm getting more aggressive, trying to screen early, intervene early, get the discs to heal, get those tears to heal so they don't go on to severe degeneration, spinal deformity, spinal stenosis. I think we're making some progress. I actually had a patient, he was the very first patient I ever treated with PRP come back last year, 11 years out. His disc looked perfectly normal after treatment. It was like, that was the longest follow up I had on a patient.

I think that there's some merit to that thought that if we intervene early with a structured healing treatment, you might prevent some of the degenerative changes that occur with the spine that most likely would result in more aggressive treatment like surgery.

Is it fair to say that discal PRP is not necessarily indicated for patients who have developed spinal stenosis, whether it's from arthritic changes, degenerative disc changes, or multiple factors?

Yeah, I think that's fair to say. What we're exploring with those patients that respond very well to an epidural steroid injection, the results are short-lived, is we are experimenting with doing the epidural with PRP. Typically, in those patients, we use a leukocyte poor PRP, because putting the white blood cells in would create a more of inflammatory change around that nerve.

A lot of the nerve healing studies with PRP have used the leukocyte poor, and we're seeing equal or better results with that. I think that is an option for some of those patients that don't want surgery.

All right. Let me walk you through a case that I encounter not uncommonly and get your thoughts. Let's say, a gentleman in his late forties who has suffered a foraminal disc herniation, maybe at L4-5, where the disc herniated out to the side on the nerve. It ended up requiring surgery because of the acute severity of it, and the neurologic symptoms on presentation.

Fast forward six months later, starting to have similar symptoms down the leg. New MRI shows there's still compression of the nerve. Questionable if it's a re herniation versus maybe they didn't just quite get it all the first time. Are those types of patients that have foraminal disc or recurrent disc herniations, can you get almost a bit of retraction of the disc with a intradiscal PRP?

That's a great challenging case, and I've dealt with that case many times. It's specifically that type of patient where we invented a catheter that we can thread into that posterior lateral corner of the disc, and inject directly inside those tears. The catheter was just recently approved, 510K approved by the FDA. We've done now about 30 patients. We're going to be collecting the data, but some of the pre and post MRI images are very encouraging, where we do see resorption of the disc material, and the patient symptoms have gone away almost completely.

It's not just the type of PRP, the concentration of PRP, but it's also how it's delivered. As you know, when you go into a disc with a straight needle, a lot of times it ends up in the nucleus, which is the center of the disc. When you inject, it's almost an inside out pressure, but the way we develop this catheter is that the fenestration on the tip of the catheter points inward, so you're almost injecting from the outside in.

Some of even the dye patterns we've seen of how it flows to the back of the disc is really encouraging. That needs more study, but that's kind of why we do our research is try to improve outcomes by looking at the type of PRP, the concentration of PRP, and how we can get it as close to the pathology as possible to improve success rates.

Yeah, Greg, that's fascinating because as you know, that type of case, that person is very quickly knocking on the doorstep of a lumbar fusion surgery, and they want to avoid that certainly if they can. Growing our option list in terms of things that we can offer to help them avoid that is quite significant. Thanks for sharing that.

There's a case study of that, exactly that patient, and how we have an MRI in our office so I could follow his clinical course. We used the catheter, and within two weeks, that disc was already showing changes on the MRI. It was really fascinating. By three months, it was completely gone. I think those are difficult patients to treat. I think we might have something really good to offer them.

Well, it's a good segue into maybe my last couple questions here. I had a couple of my colleagues, when they found out that I was going to interview you, they gave me a few questions to run by you. One of them is basically this: if a physiatrist does intradiscal PRP, and the patient reports back that their pain is significantly better, but on follow-up MRI, the structural injury looks the same, is that still considered a successful outcome with discal PRP?

Yeah, of course. If their pain and function is better, that's a success. I think what we're looking for is a cure. I think if you get the structural changes, then it's a cure. That's what we're really continue to strive for. I really do believe you have to go very high on the concentration of platelets and white blood cells. When we did our first study, just to give you a range, we probably put in one to 2 billion platelets and maybe five to 10 million white blood cells.

In our patients that we're treating currently, we're putting in five to 10 billion platelets and 50 to 100 million white blood cells. We also invented a PRP system that can concentrate to much, much higher levels. We haven't seen any adverse reaction, because this is all nanogram dosing, so very, very small doses of growth factors, despite that volume of cells. That's where we're seeing the structural changes.

If you look at the preclinical studies and animal models, once you start getting in that 20 to 40 times baseline platelet, you might be seeing regenerative effects. That's what we keep striving for.

The devil's in the details for sure. It's not just about delivering the medicine, it sounds like it's getting it in the right spot, what type you use, everything that you're teasing out for us. Then one last question here was from one of my colleagues who's a neurosurgeon, and he just asked, "Well, can we do this intraoperatively?" He said, "Basically when we do a discectomy, there's a small defect in the disc. Can we fill it with PRP?" Are you looking at any work doing this in conjunction with spine surgeons?

I know some spine surgeons that combine it with their micro-discectomy, because I think it helps the annulus heal after surgery. That's a separate study, but we do treat many patients post-discectomy with discogenic pain with intradiscal PRP successfully. We haven't written about it, but I think it's a subset of patients that seems to respond very well if there's no large recurrent herniation. It has value.

I think for them, they're right there. I don't think it would take much to put in one to two CCs of PRP gently after their surgery. I think the concern they would have is just, am I pressurizing the disc and causing something to extrude more? That would be my only concern. It really depends on how much of an annulotomy they do when they're in there. It's a judgment call.

Certainly a lot more research to be done. All right, well, let's kind of wrap up here. You've put out your new book, Heal Your Disk and Your Pain, and we're going to put links in the show notes for people who are interested in getting it. What's kind of your goal with this? If I was to say, let's look out five to 10 years from now, what would be a perfect scenario for people with low back pain and the synergy with the work you're doing?

I think we're onto something here. I've been in practice 30 years, and there's been many promising treatments that have come and gone for chronic lower back pain patients from degenerative disc disease. We know that opioids and drugs don't work. We know that surgery has its shortcomings and risks. I think we really are looking for a root cause treatment. I think we finally found one.

I didn't write the book until I was more confident on the data. It's been 12 years of doing intradiscal PRP, and well over a thousand patients with some really good research. Now, we're optimizing the preparation to improve outcomes. The purpose of the book was to get the word out to patients directly. A lot of these patients, as you know, are suffering and they've lost hope. They don't want surgery, and so they just live with the pain. I think the point of the book is just to let patients know there's new hope.

I think it has the potential to be a standard of care, but for that to happen, we all have to be collaborative. We have to share research, speak openly about our findings, report the good and the bad and the ugly, so that people are aware of the risks, and see if we can keep moving this forward. It's been a very exciting journey to finally find something that I think has staying power.

I really appreciate you giving me the opportunity to speak about this, and I'm happy to come on any time to speak about it again as we get more data.

Before I let you go, I'm going to put on my integrative health hat. When I read the books, I always read the acknowledgements or the credits, and you gave a lot of thanks to your wife, I believe was her name, Paula?

Yes, Paula, yep.

Who is a functional medicine health coach. It makes me want to ask, please share with our listeners, and I ask all my guests this, what's kind of your daily health routine? What are some tips, some hacks, books, podcasts? What do you do to keep your mind and body sharp so you can deliver this type of care to people?

I've always been very active. I was a former bodybuilder, and so I was always really into nutrition and exercise from my high school days. One of the reasons I went into rehab medicine was because I always believed the power of exercise to help people get better. Now at 60 years of age, I'm really focused on keeping my sleep cycle really strong. I have an Aura Ring, which I think works great with giving you a sleep score. I really still try to do weight training safely, because I see so many people get injured in the weight room with heavy dead lifts and power squats, too much load too quickly.

I try to work out very safely with biomechanics. I think sleep, exercise. Then through Paula, I've learned so much about the microbiome, and how to eat whole foods, good hydration, low inflammatory diet. I limit gluten and sugar, dairy, and alcohol, and then I feel best on a low carb diet. That's my body type. That's what I think the best. That's when I have good energy. I sleep well. I try to really limit my carbs.

That's what works for me. I really think out of all those things, I think sleep is the most important. You need to restore when you're working hard, and I think that's when I feel the best when I get good night's sleep.

Yeah, I totally agree, and I've mentioned it many times, but again, we'll link to Matthew Walker's book, While We Sleep. It's just full of research that to me, it's a 10X intervention over, of course, I want my patients to do everything, but if you have to choose, I think starting with a healthy sleep routine has a terrific domino effect on everything else. Vice versa, if you're not sleeping well, it's going to mitigate some of the positive benefits of your exercise and even your nutritional interventions. Yeah, thanks for sharing that. I did also an episode on nutrition and pain.

You essentially just outlined all those principles, where you're eating good, healthy, whole foods, limiting sugar, limiting dairy and gluten to some extent. I'm glad to hear you say that, because that tells me you're also taking care of yourself, which as you and I both know, we can't help others if we're not helping ourself. Thanks again for taking time. I'm glad you reached out. This is very exciting time in the field of Regenerative Spine Care. Again, we're going to link in the show notes to your book, and hopefully people can check it out. Again, is it available on Amazon?

Yes, tomorrow it's on Amazon. Then there will be an Audible version coming out in a few weeks as well.

Hope it does quite well, and look forward to circling back with you at some point in the future and seeing how things have evolved.

Sanjiv, thanks so much for having me. It was really a pleasure. I hope your listeners learn something, and look forward to speaking and collaborating in the future.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to Backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health, on the next episode of Backtalk Doc. Additional information is also available at Carolinaneurosurgery.com.