Clinical Case Study: Two-Level Lumbar Disc Degeneration in a Patient With a 20-Year History of Lower Back Pain

Q: For a patient with a 20-year history of severe lower back pain caused by disc degeneration, how do you decide on treatment when surgery isn't appropriate?

The key diagnostic step is distinguishing whether the degenerated disc is compressing the nerve root. On this patient's MRI, the affected discs showed as darkened, hardened areas, but the material was not pressing on the nerve, which is why the pain did not radiate down the leg. That finding made her a suitable candidate for a minimally invasive laser-based procedure rather than open surgery: laser energy is used to ablate the damaged disc tissue, then a pneumatic technique is applied to ensure the nerve pathway is free of adhesion. Individual outcomes vary depending on diagnosis and patient factors, and open surgery remains appropriate where imaging shows nerve compression.

August 17, 2026

CONTENTS

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

Last updated: 17 August 2026

Presenting Complaint:

A 64-year-old patient presented to me with a more than 20-year history of mechanical lower back pain that had progressively worsened. The pain pattern was positional: standing for more than approximately five minutes, or sitting for an extended period, reliably triggered symptom onset, while walking was the only activity that consistently relieved discomfort. Sleep was limited to roughly three-hour intervals before pain woke the patient. The condition had significantly affected daily function, including the ability to sit through a shared family meal.

Prior management over two decades had included oral bone-density medication, calcium supplementation, corticosteroid injections, and various traditional Chinese medicine modalities (herbal treatment, acupuncture, tuina, cupping). These interventions provided inconsistent or temporary relief. Surgical intervention had previously been offered but declined due to the risk of paralysis associated with the recommended procedure.

Diagnostic Findings

When I assessed the patient, clinical examination did not indicate a fracture. I ordered magnetic resonance imaging (MRI), which confirmed degeneration at two lumbar disc levels. On imaging, the affected discs appeared as areas of reduced signal intensity, consistent with disc desiccation and early-stage hardening. Importantly, the degenerated disc material was not compressing the adjacent nerve root — this was the key finding that explained why the patient’s pain remained localised to the lower back without radiating leg symptoms, and it shaped my treatment decision.

Treatment Approach

Based on the imaging findings, I determined that open surgery was not indicated. I performed a minimally invasive, image-guided procedure under local anaesthesia:

I used laser energy to ablate the damaged tissue surrounding the affected disc space.
I then applied a targeted pneumatic (air-based) technique to release adhesions around the nerve root, ensuring it remained free of surrounding scar tissue.
The patient was observed overnight for resolution of transient lower-limb numbness before discharge the following day.
I followed up with two sessions of physiotherapy post-procedure.

Outcome

At follow-up, the patient reported resolution of the lower back pain that had persisted for over two decades, and had returned to sitting through full family meals without discomfort — a function previously lost for years. Ongoing management consists of a single oral tablet taken twice daily. No further injections, physiotherapy, or alternative therapy sessions have been required since the procedure.

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

Ask the Doctor

Q: For a patient with a 20-year history of severe lower back pain caused by disc degeneration, how do you decide on treatment when surgery isn’t appropriate?

The key diagnostic step for me is distinguishing whether the degenerated disc is compressing the nerve root. On this patient’s MRI, the affected discs showed as darkened, hardened areas, but critically the material was not pressing on the nerve — which is why the pain did not radiate down the leg. That finding made her a suitable candidate for a minimally invasive laser-based procedure rather than open surgery: I use the laser to ablate the damaged disc tissue, then apply a pneumatic technique afterward to ensure the nerve pathway is completely free of adhesion. Individual outcomes vary depending on the specific diagnosis and patient factors, and open surgery remains the appropriate option for cases where imaging shows nerve compression — treatment decisions are always made on a case-by-case basis after clinical and imaging assessment.

— Dr Bernard Lee Mun Kam, Pain Specialist