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Edward Chang is a neurosurgeon, scientist, and a pioneering leader in functional neurosurgery and brain-computer interface technology, whose work spans the operating room, the research lab, and the engineering bench to restore speech and movement for patients who have lost these capabilities. In this episode, Edward explains the evolution of modern neurosurgery and its dramatic reduction in collateral damage, the experience of awake brain surgery, real-time mapping to protect critical functions, and the split-second decisions surgeons make. He also discusses breakthroughs in brain-computer interfaces and functional electrical stimulation systems, strategies for improving outcomes in glioblastoma, and his vision for slimmer, safer implants that could turn devastating conditions like ALS, spinal cord injury, and aggressive brain tumors into more manageable chronic illnesses.

We discuss:

• The evolution of neurosurgery and the shift toward minimally invasive techniques [2:30];
• Glioblastomas: biology, current treatments, and emerging strategies to overcome its challenges [10:45];
• How brain mapping has advanced from preserving function during surgery to revealing how neurons encode language and cognition [16:30];
• How awake brain surgery is performed [22:00];
• How brain redundancy and plasticity allow some regions to be safely resected, the role of the corpus callosum in epilepsy surgery, and the clinical and philosophical implications of disconnecting the hemispheres [26:15];
• How neural engineering may restore lost functions in neurodegenerative disease, how thought mapping varies across individuals, and how sensory decline contributes to cognitive aging [39:15];
• Brain–computer interfaces explained: EEG vs. ECoG vs. single-cell electrodes and their trade-offs [48:30];
• Edward’s clinical trial using ECoG to restore speech to a stroke patient [1:01:00];
• How a stroke patient regained speech through brain–computer interfaces: training, AI decoding, and the path to scalable technology [1:10:45];
• Using brain-computer interfaces to restore breathing, movement, and broader function in ALS patients [1:28:15];
• The 2030 outlook for brain–computer interfaces [1:34:00];
• The potential of stem cell and cell-based therapies for regenerating lost brain function [1:38:00];
• Edward’s vision for how neurosurgery and treatments for glioblastoma, Parkinson’s disease, and Alzheimer’s disease may evolve by 2040 [1:42:15];
• The rare but dangerous risk of vertebral artery dissections from chiropractic neck adjustments and high-velocity movements [1:44:45];
• How Harvey Cushing might view modern neurosurgery, and how the field has shifted from damage avoidance to unlocking the brain’s functions [1:46:15]; and
• More.

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View the Show Notes Page for This Episode

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

• Peter’s experience with debilitating back pain [3:00];
• Anatomy of the back: spine, discs, facet joints, and common pain points [14:15];
• Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30];
• Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45];
• How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00];
• The pathology of bulging discs [43:00];
• The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45];
• The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00];
• The significance of strength and stability in preventing injuries and preserving longevity [1:08:00];
• Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15];
• Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45];
• Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:38:30];
• When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:30];
• Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:15];
• Tarlov cysts: treatment and surgical considerations [2:00:00];
• The evolution of patient assessments and the limitations of MRI [2:02:00];
• Pain relief related to stiffness and muscle bulk through training [2:06:45];
• Advice for the young person on how to keep a healthy spine [2:14:00];
• Resources for individuals dealing with lower back pain [2:25:15]; and
• More.

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