A 48-year-old male presents with 2 years of persistent left leg radicular pain following an L4-5 decompressive laminectomy. Surgery was performed for left L5 radiculopathy with good initial relief of leg symptoms, but pain returned at 3 months post-op and has been worsening. Current pain is 7/10 in the left posterior thigh and calf with intermittent burning and tingling. He rates his back pain at 3/10 (mild). He has failed physical therapy, gabapentin 1800 mg/day, duloxetine 60 mg, and two transforaminal epidural steroid injections (minimal relief). He is on opioid therapy (oxycodone 10 mg TID) and wants to reduce his medication dependence.

Well-healed midline lumbar scar. Left lower extremity: positive Tinel sign over the left buttock/sciatic notch region. Decreased sensation in the left L5-S1 dermatomes. Left ankle reflex diminished. Strength 4+/5 left EHL, otherwise 5/5. Mild antalgic gait. No signs of myelopathy.

MRI lumbar spine shows post-surgical changes at L4-5 with epidural fibrosis (scar tissue) around the left L5 nerve root. No recurrent disc herniation. No hardware present. EMG/NCS shows chronic left L5 and S1 radiculopathy with fibrillation potentials suggesting ongoing denervation.

EMG/NCS shows chronic left L5 and S1 radiculopathy with fibrillation potentials in left tibialis anterior and medial gastrocnemius, suggesting ongoing denervation. Left H-reflex is prolonged. No evidence of peripheral neuropathy.