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A middle-aged patient with a history of mild, intermittent low back pain presented with several months of new right leg pain and numbness in the L5 dermatomal distribution. The pain had not improved with trials of physical therapy, gabapentin or tramadol. The patient denied weakness or bowel and bladder symptoms.
Physical examination was significant for reproduction of leg symptoms with spine flexion and straight leg raise. Palpation of the right lumbar paraspinal musculature produced mild discomfort and myofascial spasm. Strength, sensation and reflexes were normal in the bilateral lower extremities. MRI at 1.5 T of the lumbar spine revealed a large L4–L5 disc extrusion producing severe central canal stenosis and mild-to-moderate bilateral neuroforaminal narrowing (figure 1). Near complete resolution …