• a woman is suffering pain from L5-s1 Disc Herniation with Nerve root adhesion

Clinical Case Study: Minimally Invasive Treatment for L5-S1 Disc Herniation with Nerve Root Adhesion

August 19, 2026

CONTENTS

shoulder pain specialist singapore

Written by Dr Bernard Lee Mun Kam,
Founder & Consultant Pain Specialist, Singapore Paincare Center
MBBS (NUS) · M Med (Anaesthesiology) (NUS) · FFPMANZCA (ANZCA)

Last updated: 19 August 2026

Presenting Complaint:

A patient in her 40s had lower back and left leg pain that kept coming back for several years. It started after a fall.

Over time, the pain spread. What began as pain in one buttock turned into constant lower back pain, with numbness running down her left leg. Some flare-ups were severe enough that she couldn’t get out of bed. At times, her lower body went numb for up to 30 minutes.

She had already had spinal surgery elsewhere to relieve the pressure. It helped for a while, but the pain came back and slowly got worse.

Diagnostic Findings

Earlier scans had shown a disc pressing on a nerve. On examination, she could not fully straighten her left leg. A specialist she had seen before felt further surgery was unlikely to help, and referred her for pain management instead.

When I reviewed her case, I ordered fresh imaging. It showed that the disc between her L5 and S1 vertebrae had herniated by about 40%, pressing on the nerve root beside it. That explained why she couldn’t straighten her leg.

I also found something else: the nerve itself had become stuck to nearby bone. This was likely a result of her earlier surgery and years of ongoing inflammation. This adhesion, not just the herniation, was a major reason her pain kept coming back.

Because of this, I chose a minimally invasive approach that could treat both problems, the disc herniation and the nerve adhesion, in one sitting. This meant she could avoid another open surgery.

Treatment Approach

  1. I used laser energy to shrink the centre of the damaged disc. This let the herniated part pull back into place. This step took about 45 minutes.
  2. The nerve had stuck to nearby bone, so I used a small balloon catheter to gently separate it and free the nerve. This adhesiolysis step took about 90 minutes.
  3. As feeling returned to the nerve during the procedure, I worked with the anaesthetist to adjust her anaesthesia and keep her comfortable.
  4. About a month later, I gave her a series of five injections in the piriformis muscle, in her buttock, to ease tightness caused by ongoing nerve sensitivity.

Outcome

  • After treatment, the patient reported around 80% overall improvement. Her lower back pain was fully gone.
  • She still had some numbness in her left leg. Walking fast or sitting for long periods remained a challenge.
  • She kept up physiotherapy, walked regularly, and went swimming. At follow-up, her recovery continued to improve.

This outcome reflects one individual case. Treatment suitability and results depend on each patient’s specific diagnosis and clinical assessment.

Ask the Doctor

Q: What condition did this patient have, and how was it treated?

She had a disc herniation between the L5 and S1 vertebrae. The disc had bulged out by about 40%, pressing on a nerve so she couldn’t straighten her left leg.

I used laser energy to shrink the disc material back into place. Then I used a small balloon to free the nerve, which had become stuck to bone from her earlier surgery.

About a month later, I treated the piriformis muscle in her buttock with a series of injections, since ongoing nerve sensitivity had made it tight.

With consistent rehabilitation, the scar tissue around the nerve tends to heal well, and the chance of the problem coming back is low.

— Dr Bernard Lee Mun Kam, Pain Specialist