Back Pain Specialist NYC

Most Back Pain Is Not a Surgical Problem

It is worth saying this plainly at the outset, because patients often arrive expecting the worst. Most episodes of back pain improve within a few weeks with time, movement, and conservative care. Even findings that look alarming on an MRI — a bulging disc, degenerative changes, arthritis of the facet joints — are extremely common in people with no pain at all, which is why imaging alone never decides treatment.

What matters is whether the imaging findings line up with your symptoms and your physical exam. A disc herniation on the left at L5–S1 means something quite different in a patient with pain running down the left leg to the foot than in a patient with pain confined to the middle of the lower back. Reconciling those three things — story, exam, and images — is most of what a specialist evaluation actually is.

What Causes Lower Back Pain

Back pain rarely traces to a single event. Most patients describe one moment when the pain started, but the structural changes that made that moment possible usually developed over years. The most common sources include:

• Muscle and ligament strain. The most frequent cause of an acute episode, often after lifting, twisting, or an unaccustomed activity. Painful and limiting, but it typically settles over days to weeks.
• Lumbar disc herniation. The soft inner material of a disc pushes through a tear in its outer ring and irritates a nerve root. The signature is pain that travels below the knee, often with numbness or tingling along a specific path, and it is frequently worse with sitting, coughing, or bending forward.
• Degenerative disc disease. Discs lose height and water content with age. This shifts load onto the joints behind them and can produce stiffness and pain that is worse in the morning or after prolonged sitting.
• Facet joint arthritis. Wear in the small paired joints at the back of each spinal level. Pain is typically felt across the lower back, worse with standing and extending backward, and often eased by leaning forward.
• Lumbar spinal stenosis. Narrowing of the canal or the openings the nerves exit through, usually from arthritic overgrowth. The classic pattern is leg pain, heaviness, or cramping that comes on with walking and resolves within a minute or two of sitting or leaning on a shopping cart.
• Spondylolisthesis. One vertebra slips forward relative to the one below, narrowing the space around nearby nerves and sometimes producing both back and leg symptoms.
• Adult degenerative scoliosis. A curve that develops later in life as discs and facet joints wear unevenly. Often causes leg symptoms and difficulty standing upright as much as back pain itself.
• Osteoporotic compression fracture. Fragile bone can fracture under ordinary load, sometimes with no memorable injury. Suspect this with sudden, focal pain in an older adult, particularly alongside loss of height or increasing forward stoop.
• Sacroiliac joint dysfunction. Pain at the very base of the spine, off to one side, sometimes referred into the buttock or groin. Frequently mistaken for a disc problem.

Not everything that presents as back pain originates in the spine. Hip arthritis in particular refers pain into the buttock and groin and is regularly mistaken for a lumbar problem. Kidney stones, abdominal conditions, and vascular problems can all mimic back pain as well, which is part of why the initial evaluation is deliberately broad.

What Increases the Load on Your Spine

Several everyday factors influence how quickly the lumbar spine wears and how readily it becomes painful. None of them cause back pain on their own, and genetics plays a substantial role that no habit fully offsets — but these are the levers within your control:

• Repetitive or awkward lifting. Load close to the body is far easier on the spine than load held out in front of you. Bending and reaching at the same time is the combination that most often produces an acute strain.
• Prolonged static posture. The problem with sitting is less the position than the duration. Holding any single posture for hours loads the same structures continuously. Changing position every 20 to 30 minutes matters more than achieving a perfect one.
• Workstation setup. A screen too low pulls you into sustained forward flexion, which increases pressure on the discs and fatigues the muscles holding you upright.
• Deconditioning. The abdominal and back muscles share load with the spine. When they weaken, more of that load transfers to the discs and joints.
• Body weight. Additional weight carried around the midsection shifts the pelvis forward and increases the work the lower back does to hold you upright.
• Smoking. Nicotine impairs blood supply to the discs and is one of the clearest risk factors for both degeneration and for a fusion failing to heal. If surgery is a possibility, this is the single most valuable thing to change.
• Age. Disc height, hydration, and canal dimensions all change over decades. This is not preventable, but its consequences are very manageable.

Non-Surgical Treatment Comes First

Dr. Kim begins with the least invasive option that fits the diagnosis, and coordinates care with pain management specialists, physiatrists in physical medicine and rehabilitation, and physical therapists. Non-operative treatment includes:

• Physical therapy with a clinician experienced in spine conditions. Targeted strengthening, hip and hamstring mobility, and load-management retraining, matched to your specific diagnosis rather than a generic back program. This is the single highest-yield intervention for most patients.
• Activity modification rather than rest. Extended bed rest generally makes back pain worse. Staying as mobile as symptoms allow, while temporarily setting aside the specific activities that reproduce the pain, works better.
• Medication — anti-inflammatories, muscle relaxants, and neuropathic agents when nerve symptoms are present. If you find yourself relying on any pain medication daily for more than a short stretch, that is worth a conversation with a physician rather than a reason to continue.
• Image-guided injections. These serve two purposes: reducing inflammation around an irritated nerve, and helping confirm which level is generating the pain when imaging shows changes at several.
• Ergonomic and workstation changes — screen height, chair support, and breaking up long periods of sitting or standing.

Surgery enters the conversation when symptoms persist despite an adequate trial of the above, when there is weakness or nerve compression, or when a deformity is documented to be progressing.

What a Specialist Evaluation Involves

A first visit is mostly conversation and examination. The imaging supports that, not the other way around.

• History. Where the pain is, where it travels, what makes it better and worse, how long you can walk or stand, what treatment you have already tried, and how the pattern has changed over time. The details that distinguish one diagnosis from another are usually in this part.
• Physical examination. Strength, sensation, and reflexes in specific nerve distributions, gait, spinal alignment and flexibility, and hip range of motion to rule the hip in or out as a source.
• X-rays. Standing films show alignment under load, which lying-down imaging cannot. Full-length standing views are used when a deformity is suspected.
• MRI. The best view of discs, nerves, and soft tissue. Most useful when the clinical picture already points somewhere specific.
• CT. Better detail of bone, and used when fusion healing or hardware position needs assessment.
• Diagnostic injections. Occasionally the most reliable way to confirm which level is responsible before committing to a plan.

Bring your actual images if you have them — on disc or via a digital link — rather than just the written report. Dr. Kim will review them himself.

Surgical Options for Back and Leg Pain

Spine surgery does one of three things: it takes pressure off a nerve, it stabilizes a segment that has become unstable, or it corrects alignment. Which operation is appropriate depends on which of those problems you have.

• Microdiscectomy. Removal of the fragment of herniated disc pressing on a nerve root. Among the more predictable spine operations for leg pain that has not settled on its own.
• Laminectomy and decompression. Removal of bone and thickened ligament to enlarge the space around compressed nerves. The standard treatment for lumbar stenosis when walking limitation has become the dominant problem.
• Foraminotomy. Enlarging the specific opening a nerve root exits through, when compression is at that point rather than centrally.
• Lumbar decompression and fusion. Used when decompression alone would leave the segment unstable, as with spondylolisthesis or a deformity that needs correction. Instrumentation holds position while bone graft consolidates.
• Osteotomy and deformity correction. Controlled bone cuts to restore alignment when a curve or forward stoop has become fixed. See spinal deformity surgery.

Being Honest About Outcomes

Surgery is considerably more predictable for some problems than others, and you deserve to know which category yours falls into before deciding.

Leg pain from an identifiable compressed nerve responds well. When a specific structure is pressing on a specific nerve and the exam matches, decompressing it reliably relieves that leg pain, often quickly. Walking distance in lumbar stenosis usually improves substantially.

Back pain alone, without a clear structural target, is less predictable. This is the most important thing to understand. Surgery treats structural problems. When back pain has no single identifiable source — which is common — an operation may not improve it, and it is reasonable for a surgeon to advise against one. Dr. Kim will tell you when that is the case.

Where surgery does succeed, the realistic gains are meaningful: relief of leg pain, more walking and standing tolerance, reduced reliance on pain medication, a return to work, and the improvement in mood and sleep that tends to follow when chronic pain lifts. Numbness that has been present a long time may improve only partially, and a fusion permanently changes motion at the levels involved. Both are worth discussing before you decide.

Read more about recovering from spine surgery.

About Han Jo Kim, MD

Dr. Kim earned his medical degree at Columbia University College of Physicians and Surgeons and completed his orthopedic surgery residency at Hospital for Special Surgery, followed by two fellowships at Barnes-Jewish Hospital at Washington University in St. Louis — one in adult and pediatric spinal deformity and reconstruction, and a second in cervical spine surgery. He is board certified by the American Board of Orthopaedic Surgery.

At HSS he serves as Director of the Complex Spine and Scoliosis Center, Spine Fellowship Director, and Chair of the Fellowship Committee, and holds the David B. Levine, MD Endowed Chair in Scoliosis. He is also an attending orthopedic surgeon at NewYork-Presbyterian Hospital, has authored more than 400 peer-reviewed articles, and was named to Becker’s Spine Review’s 150 Best Spine Surgeons in America in 2024. He speaks English, Spanish, and Korean.

Dr. Kim also spearheaded the enhanced recovery pathways developed at HSS, designed to reduce pain and shorten hospital stays after spine surgery.

Read more about Dr. Kim, see his full practice overview, or browse patient testimonials.

Related Conditions

If your symptoms are primarily in the neck, shoulder, or arm rather than the lower back, see cervical spine surgery. For curvature of the spine in adults or children, see scoliosis surgery in New York. A full list is on the services page.