Ortho Dx: Progressive neurologic deficits in a man with sciatica

A 65-year-old man presents with right-sided sciatica that occasionally radiates down the posterior lateral thigh to the level of the ankle. Magnetic resonance imaging (MRI) is ordered, which shows right-sided foraminal stenosis at L4-L5 and L5-S1, with a small disc herniation at L4-L5. Congenitally short pedicles causing central stenosis are also noted.

The patient failed a trial of ...