Och Spine

Minimally invasive spine surgery may be performed to relieve pressure on a spinal nerve or stabilize the vertebral bones and spinal joints. At Och Spine at NewYork-Presbyterian, we have state-of-the-art equipment and training, so we can use a minimally invasive approach to treat various spinal conditions, including lumbar disc herniation, lumbar stenosis, and sciatica. Some of our advanced minimally invasive surgical options include:

• Microdiscectomy – a procedure where a herniated disc is removed to take the pressure off a nerve
• Spinal decompression – a procedure where ligaments and bone are shaved to remove pressure off the nerves
• Lumbar spinal fusion – a procedure used to stabilize vertebrae that are causing pain
• Oblique lateral interbody fusion (OLIF) – a procedure in which the surgeon accesses and repairs the lower spine from the front and side of the body
• Extreme lateral interbody fusion (XLIF) – a procedure performed through the side of the body
• Multilevel minimally invasive surgery
• Robot-assisted spinal fusion

Orthopedic surgeons and neurosurgeons perform spine surgery. Both specialties are equally qualified to treat spinal conditions involving the nerves and bones of the spinal column. When selecting a spine surgeon, whether choosing an orthopedic surgeon or a neurosurgeon, it's important to find a doctor with expertise in treating conditions of the spine. At Och Spine at NewYork-Presbyterian, our neurosurgeons and orthopedic spine surgeons are fellowship-trained, which means they have undergone specialized training in how to treat these spinal conditions effectively.  Our patients have access to medical specialists across hundreds of specialties, so if they experience co-occurring conditions, our doctors can coordinate care to ensure optimal outcomes for patients.

Typically, when a patient presents with a painful condition due to a herniated disc, we recommend non-surgical treatments such as physical therapy and other conservative care management first. If the patient does not improve with physical therapy or has severe pain, we have fellowship-trained non-surgical spine specialists. They can manage the patient with medication and spinal injections. If the patient still doesn't improve, our multidisciplinary staff is well equipped to promptly get you an appointment with one of our expert surgeons. More than 85% of our patients do not require surgery for herniated discs.

For patients with spinal stenosis, we typically start with non-operative treatment options like pain management and epidural injections. Physical therapy is also beneficial for many patients. Our physical therapists can prescribe exercises aimed at increasing the flexibility of the limbs and strengthen the core muscles, which allows those with spinal stenosis to function more normally. In cases where there are degenerative changes of the spine that don't respond to conservative care, our doctors may recommend decompression of the pain generating nerves. This may entail a minimally invasive spinal stenosis surgery or a decompression surgery or a limited spinal fusion in some cases. These procedures enable patients to return to walking and other activities without previous pain and restrictions.

Yes. Most patients with spinal stenosis report pain when they walk before surgery. After surgery, the nerves are no longer compressed, and patients can walk farther without radiating pain.

When conservative care, like physical therapy or pain management, doesn't work, surgery may be beneficial depending on the condition you have. Back pain related to instability, trauma, or deformity will likely be relieved after surgical intervention. But there are conditions where surgical treatment is not appropriate for back pain. You should schedule an appointment with our spine specialists for a comprehensive evaluation.

Surgery is not the only option for treating back or neck pain. Unless the disorder is an emergency issue, the first line of treatment for back and neck pain is physical therapy and lifestyle changes. In general, active patients are less likely to suffer from disabling pain, so it's recommended to exercise as advised by your care team. Other treatment options include manual therapy, exercise, postural training and reeducation, injections like nerve blocks, and complementary medicine.

When prescribing medications to alleviate back and neck pain, we often recommend over-the-counter (OTC), non-steroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin IB), naproxen (Aleve), or aspirin. It is important to speak with your doctor about proper dosage for OTC medication or potential interactions with other medicines, as inappropriate usage can cause serious health problems for some.

Many patients do not need to stay in the hospital overnight after surgery. Patients who need to stay overnight are cared for by staff with specialized training who are dedicated to the care of spinal patients. Hospital patients may be moved to the intensive care unit or post-operative floor where they are cared for by physician assistants, nurses, hospitalists, and their surgeon. Patient discharge depends on the type of surgery. Before discharge — whether it's the same day or a week later — patients are seen by a physical therapist who helps them to get moving shortly after the procedure. Additional physical therapy or occupational therapy may be prescribed for patients when they go home. Depending on the type of surgery, some patients are back to their healthy life within days, while recovery for others may take longer. Your doctor and team will discuss with you your recovery plan and help prepare you for your healing journey.