Published on Oct. 22, 2026
Low-back pain is one of the most common reasons people seek medical care, but the condition many patients associate with severe back pain — a herniated disc — accounts for only a small portion of surgical cases. Even when a herniated disc is causing sciatica, numbness, tingling or weakness, surgery is not always the first or only answer.
That space between diagnosis and treatment planning is where spine care is changing. At the MemorialCare Orthopedic & Spine Institute at Long Beach Medical Center, specialists look at all options that are available now due to advances in technology and injection therapies to help guide the next step — from physical therapy and targeted injections to a surgical evaluation only if needed, when other options are exhausted.
“A herniated disc does not necessarily mean the patient needs surgery,” said Andrew Hanna, D.O., medical director, Back & Neck Health Center, MemorialCare Orthopedic & Spine Institute, Long Beach Medical Center. “Our first job is to understand whether the disc is actually causing the patient’s symptoms and whether a nerve is being compromised.”
Research suggests that only a small share of people with low-back pain are truly diagnosed with sciatica caused by a herniated disc, and many improve without surgery. That makes the bigger question not simply whether a patient needs back surgery, but how specialists decide which treatment is right at each step.
MemorialCare Orthopedic & Spine Institute’s coordinated spine program brings nonsurgical spine care, image-guided procedures, rehabilitation and advanced surgical expertise together in one place, so patients can move to the appropriate level of care without starting over at each step.
The Space Between Physical Therapy and Surgery
For many patients, treatment starts with physical therapy and other conservative care to improve strength, mobility and daily function. But if symptoms continue, that does not always mean surgery is the only next step. For some patients, image-guided injections may help calm pain linked to an irritated or compressed spinal nerve.
At the Back & Neck Health Center at MemorialCare Orthopedic & Spine Institute, physicians use X-ray guidance to help place targeted spine injections near the affected nerve. Research has found that epidural steroid injections may provide short- and medium-term relief for some patients with sciatica related to a herniated disc, although they are not a permanent fix for everyone.
“As a pain management specialist, I can identify the source of a patient’s pain and use fluoroscopic guidance to deliver treatment precisely where it is needed,” Dr. Hanna said. “That expertise allows us to personalize the next step and, when appropriate, address symptoms without immediately moving to surgery.”
Instead of moving straight from MRI to surgery, patients can start with an evaluation at the Back & Neck Health Center, where a team offers nonsurgical and minimally invasive treatment options. If symptoms do not improve or surgery becomes the right choice, patients can be connected with a spine surgeon within the same institute.
When Surgery Becomes the Right Treatment
Starting with nonsurgical care does not mean surgery is off the table. It means surgeons can focus on the patients most likely to benefit, including those with severe or ongoing arm or leg pain, worsening weakness, loss of function or symptoms that do not improve with appropriate nonsurgical treatment within six to 12 weeks.
“Surgery may be the most effective solution when pain, weakness or numbness continues despite nonsurgical treatment,” said Brandon Ortega, M.D., spine surgeon, MemorialCare Orthopedic & Spine Institute, Long Beach Medical Center. “The decision is based on the patient’s symptoms, how those symptoms affect daily life, what imaging shows and how the patient has responded to previous treatment.”
When surgery is needed, the procedure depends on what is causing the nerve compression and whether the spine also requires stabilization. For appropriately selected patients, MemorialCare spine surgeons may use minimally invasive techniques to remove disc material pressing on a nerve while limiting disruption to nearby muscles and healthy tissue. When a procedure requires implants or stabilization, advanced navigation can help surgeons plan around the patient’s anatomy and guide instruments and implants during surgery.
The MemorialCare Orthopedic & Spine Institute offers navigation technologies such as Stryker Q Guidance and ExcelsiusGPS to support surgical planning and navigation for appropriate procedures requiring instrumentation or stabilization. In fact, the MemorialCare Orthopedic & Spine Institute led these advances by being first in California to adopt Stryker's Q Guidance System with Spine Guidance Software and Copilot. This system revolutionizes spinal surgery by enabling precise, computer-assisted navigation for both open and minimally invasive spine procedures.
"Performing our first case with Stryker Q Guidance and Copilot showed how real-time, three-dimensional navigation can give surgeons greater confidence as we work around sensitive anatomy and place instrumentation,” said Dr. Ortega. “MemorialCare’s investment in advanced spine technology gives us another tool to tailor surgery to each patient, with the potential to improve surgical accuracy and support better outcomes.”
Additionally, MemorialCare Orthopedic & Spine Institute also provides complex, multilevel and revision spine surgery, with access to nonsurgical specialists, orthopedic spine surgeons, neurosurgeons and rehabilitation experts through one coordinated program. This brings a level of specialized care often associated with major academic or specialty centers to the community.
One Program, More Treatment Options
What distinguishes the MemorialCare Orthopedic & Spine Institute from others is not one treatment or technology. It is a connected care pathway that supports patients from evaluation through recovery. By bringing nonsurgical spine care, interventional treatment, spine surgery and rehabilitation together through one local program, MemorialCare Orthopedic & Spine Institute delivers personalized spine care right here in the community while staying miles ahead through a fully connected approach.
Learn more about the MemorialCare Orthopedic & Spine Institute.