A 72-year-old male with a mechanical aortic valve on warfarin (target INR 2.5-3.5) presents with 2 months of left-sided L5 radiculopathy. Pain is 8/10, limiting his ability to walk more than one block. He has failed physical therapy and gabapentin. His cardiologist manages his anticoagulation. Current INR is 2.8. He also takes aspirin 81 mg daily per his cardiologist's recommendation.

Positive left straight leg raise at 50 degrees. Weakness of left EHL (4/5). Diminished sensation over the left lateral leg and dorsal foot. Antalgic gait. No upper motor neuron signs.

MRI lumbar spine shows a left paracentral disc herniation at L4-5 with compression of the left L5 nerve root. Moderate left lateral recess stenosis at L4-5.