Before some patients meet a spine surgeon, they have already watched the operation. They have seen a laminectomy demonstrated on TikTok, watched surgical instruments at work and heard physicians explain why the operation they thought they needed may not be the answer.
That has changed the starting point of the conversation for Zayed Almadidy, MD.
Dr. Almadidy, a neurosurgeon at Oak Brook, Ill.-based Advocate Health Care, has more than 1 million followers on TikTok and hundreds of thousands more on Instagram, where he is known as “Dr. Z.” He takes viewers into a world that medicine has traditionally kept largely out of sight, using models, instruments and footage from the operating room to explain what spine surgeons actually do.
His ambition, however, is not to make spine surgery seem simple.
“The whole point of my channel is not to simplify the medicine,” Dr. Almadidy told Becker’s. “It’s to simplify the communication behind the medicine.”
The distinction matters. Spine surgery is a field built on qualifications: The same operation can be necessary for one patient and inappropriate for another. A treatment gaining ground does not necessarily make the one before it obsolete. Sometimes the most important thing a surgeon can tell a patient is that surgery is not the answer at all.
Those ideas do not fit naturally into an internet culture that rewards certainty and speed. Dr. Almadidy is trying to make them fit anyway.
What happens behind the doors
The operating room has always had a mystique. Patients see the restricted-access signs. They hear words such as decompression, fusion and laminectomy. Then the doors close.
“Not a lot of people know what happens in the operating room,” Dr. Almadidy said. “It’s like this big question mark.”
His answer is often to show rather than tell. He demonstrates procedures on models and explains the instruments surgeons use. Sometimes he brings the camera into the operating room when a case is set up and walks viewers through the tools before surgery.
“What I’ve found is that people tend to learn and understand things better by just seeing it,” he said.
A demonstration does not have to replicate an entire operation to be useful. A laminectomy, for example, can stand alone or be one component of a larger procedure. Once patients can visualize that piece, Dr. Almadidy said, the rest becomes easier to understand.
That ability to open a window into surgery is part of what makes social media powerful. It is also what makes getting the explanation right consequential.
The problem with a simple answer
Consider spinal fusion. Dr. Almadidy repeatedly encounters a perception online that fusion is something patients should avoid. Motion-preserving technologies are expanding the alternatives available to some patients, but he believes the broader debate can obscure the question that should come first. Does this patient actually need a fusion?
“Not everybody is a good candidate for a fusion surgery,” he said. “You really need to make sure that the indication is actually there.”
When it is not, another treatment may be more appropriate. When it is, he said, fusion remains one of spine surgery’s most important tools.
His trauma practice makes that distinction difficult to miss. At Park Ridge, Ill.-based Advocate Lutheran General Hospital, a Level I trauma center, Dr. Almadidy treats patients whose spinal injuries can create profound instability. For some of those patients, preserving motion is not the objective because excessive motion is precisely what needs to be stopped.
“At that point, the movement is the pathology,” he said.
It is the kind of distinction that can disappear when a complicated medical question is reduced to whether an operation is “good” or “bad.” For Dr. Almadidy, the challenge of practicing medicine online is preserving everything between those two poles.
What cannot fit into 60 seconds
That sometimes means deciding not to explain something at all. Dr. Almadidy gravitates toward what he calls the “bread and butter” components of surgery: a laminectomy or another discrete step that can be demonstrated clearly. He draws the line when the compression required by the medium begins to distort the medicine.
“I think I would be doing the more complex procedures an injustice if I tried to explain them within 60 seconds,” he said.
The constraint is not really 60 seconds. It is what gets lost inside them.
A short video can show how a surgeon removes bone to decompress neural structures. It is much harder for one to capture every anatomical, clinical and patient-specific judgment that determines whether that operation should happen in the first place.
So Dr. Almadidy often explains a piece rather than pretending he can explain the whole. It is a small editorial choice with a larger principle behind it: Making medicine understandable is useful only if the meaning survives the translation.
The surgeon who tells viewers not to have surgery
Perhaps the most telling part of Dr. Almadidy’s online presence is what he tells people about operations he performs for a living.
They may not need one. He said patients are increasingly aware that an appointment with a spine surgeon does not automatically end in an operating room.
“There is a lot of underestimation of the power of physical therapy, steroid injections, nonoperative management and rehabilitation,” he said. “A lot of these treatments genuinely help.”
For many nonemergency conditions, Dr. Almadidy wants patients to arrive expecting a discussion of those options.
“You should not expect that surgery is the first-line intervention for a disease pathology,” he said.
There are important exceptions. A patient arriving after severe trauma with paralysis presents a fundamentally different question from someone who has lived with radiating leg pain for months.
But that distinction is also the point. The value of a more informed patient is not that the patient arrives knowing which operation to request. It is that the conversation can begin with a better understanding of the choices.
The information vacuum
Dr. Almadidy sees another reason for physicians to participate online: Patients are going to look for answers whether surgeons provide them or not.
What they find can range from evidence-based medical information to personal anecdotes, misleading claims and advice shaped by financial incentives.
Leaving social media does not leave that space empty.
“We need to create a reliable, accessible repository of information about spine health and spine care,” he said.
He is careful to distinguish that from turning spine surgery into entertainment. Dr. Almadidy said physicians should explain the anatomy, treatments, alternatives and reasoning behind care without giving viewers a sensationalized version of medicine. They should also be willing to contradict themselves over time.
A video that reflects the evidence today may not reflect it a decade from now. If the science changes, he said, his message should change with it.
That willingness to revise may be one of the most important things a physician can bring to a medium built around confident declarations. “The physician really is a servant to the public,” he said.
Surgeon first
For someone who has become recognizable to millions of people online, Dr. Almadidy is strikingly insistent that the platform remain secondary.
“First and foremost, I am a doctor. I am a surgeon,” he said. “That’s really what I do.”
He largely keeps his online presence separate from his work at the hospital. He describes it as a hobby and said if the audience disappeared tomorrow, his identity as a surgeon would remain unchanged.
The distinction gets at the paradox of his platform.
Dr. Almadidy has become visible by demystifying a profession that has historically operated largely out of public view. Yet he does not think the goal is for patients to know more about him.
It is for them to know more before they need him. The first conversation about spine care no longer necessarily begins in the exam room. It may begin months earlier, with a search bar, an algorithm and a 60-second video.
Surgeons cannot control what patients encounter there. Dr. Almadidy believes they can help determine whether some of it is worth trusting.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
