Yes, an orthopedic mattress can include springs. Orthopedic performance is not defined by whether springs exist, but by whether the mattress supports proper spinal alignment. A high-quality spring system (such as pocket springs) can distribute body weight more evenly and improve airflow. Hybrid mattresses (springs plus comfort layers) often combine strong support with pressure relief. However, low-quality spring systems may lead to sagging, noise, or loss of support over time. If choosing a spring mattress, review coil gauge, coil count, zoning for lumbar support, edge support structure, and the materials used in the comfort layers. In short, springs can enhance orthopedic benefits when engineered well, but poor design can worsen pain and sleep quality.