A 52-year-old female was referred after two right L5-S1 transforaminal epidural steroid injections provided zero relief. She reports right-sided low back and buttock pain rated 6/10 for 8 months. Pain is described as a deep ache in the right low back and gluteal region, sometimes extending to the posterior thigh. She does not have pain below the knee. Original referral was for 'right L5 radiculopathy' based on MRI findings.

No radicular signs: strength 5/5 in all myotomes, intact sensation, symmetric reflexes. Negative straight leg raise bilaterally. Right-sided paraspinal tenderness at L4-5 and L5-S1. Pain with lumbar extension and right-sided extension-rotation. Fortin finger test equivocal. SI joint provocation: positive FABER and thigh thrust on the right, negative distraction, compression, and Gaenslen tests (2/6 positive).

MRI lumbar spine shows a small right paracentral disc protrusion at L5-S1 contacting but not significantly compressing the S1 nerve root. Moderate bilateral facet arthropathy at L4-5 and L5-S1. Mild disc desiccation at L4-5.