Procedure of the Month

The patient this month is a 26 year old otherwise healthy female with a 4 month history of sudden-onset lower back pain radiating to the right lower extremity.  Her pain is 10% back and 90% leg.  She rates her daily pain at 7/10 with exacerbation to 10/10 with minimal activities.  Having failed to improve with activity modification, NSAID’s, a short course of oral steroids, physical therapy and lumbar epidural steroid injections (ESI) x 2, she is telling you that she wishes to have definitive treatment.  A physical exam shows that she can straight raise her leg at 20 degrees with pain radiating down her leg to the lateral aspect of her foot. She has no motor or sensory deficits and decreased reflex right Achilles.

Figure 1. Saggital MRI Lumbar spine.

Based on what you know so far and the MRI images of the lumbar spine (Figures 1 and 2), what would pick as the best treatment option for this patient?

(Click on one choice below)