<s>[INST] Sir My brother aged 48 years has L-4-5 diffuse disc bulge with Left paracentral-left intra foraminal protrusion of disc along with ligamantum flavum hypertrophy causing mild compression on the cal sac and mild narrowing of left lateral foramina with left lateral recsess stenosis . Please advise if any therapy other than surgery is possible for treatment and pain management . Please inform by return mail and oblige. [/INST] Hello, Thanks for the query, Please note that the decision regarding the surgical treatment in patients with disc disease depends upon the clinical data., NOT ON MRI DATA. If there are no signs of neurological deficits pertaining to a nerve root, conservative treatment is sufficient. I am sorry that i donor know your clinical status. Conservative treatment for this problem will be to take medications like Gabapentin, pregabalin etc. along with physiotherapy. If this fails, please get evaluated by a neurologist and if there are signs of nerve root compression, you may opt for surgery later Hope this helps Chat Doctor.  </s>