A 58-year-old male presents with 3 months of right-sided low back pain radiating down the posterolateral leg to the dorsum of the foot. Pain is rated 7/10 and worsened by sitting and forward bending. He has failed 6 weeks of physical therapy, oral NSAIDs, and a course of gabapentin. He works as an accountant and is having difficulty sitting through meetings.

Antalgic gait favoring the right side. Positive straight leg raise at 45 degrees on the right. Weakness of right EHL (4/5) and tibialis anterior (4+/5). Diminished sensation over the right lateral leg and dorsal foot. Reflexes symmetric at the knee and ankle bilaterally.

MRI lumbar spine shows a right paracentral disc herniation at L4-5 contacting and displacing the traversing right L5 nerve root. No central canal stenosis. No other significant disc pathology. Mild bilateral facet arthropathy at L4-5 and L5-S1.