<s>[INST] Hello doctor, My 68 years old mother is having severe back pain since last few months. Whenever she stands up for some time, her back pain starts, and it goes down to the entire legs. It becomes so intolerable that she has to sit down somewhere immediately to avoid pain, and she gets relief after she lies down on the bed. Recently, she did an MRI of the lumbar spine with the ischial region, and the findings and impression of the MRI are, mild scoliosis is seen with concavity to the left. A mild forward shift of L4 over L5 is observed. Small osteophytes are seen. L4-L5 disc height is reduced. Lower lumbar discs are desiccated. Posterior protrusions of L4-L5 discs are observed compressing the thecal sac. Encroachment of both L4-L5 and L5-S1 foramina is noted. Ligamental and facet hypertrophy is also contributing to foraminal stenosis. The impression is grade I listhesis of L4 over L5 with mild scoliosis. Early changes of lumbar spondylosis with desiccation of lower lumbar spine. Posterior protrusions of L4-L5 and L5-S1 discs compressing the thecal sac. Encroachment of both L4-L5 and L5-S1 foramina. Screening of pelvis with both hips do not show any significant abnormality. She has diabetes since the last ten years. And hypertension since last 15 years, for which she takes antihypertensive medications. She has a history of varicose veins, for which endovenous laser ablation was done. She underwent right knee replacement two years ago. She also has a history of anal fissures, which was surgically treated twice. I request you to please give me your opinion about this and best possible line of treatment to relieve back pain at the earliest, as it is intolerable now. I have attached her reports for your better understanding. [/INST] Hi. I have seen your mother's reports (attachment removed to protect patient identity). I hope it helps. If you have any further query, please ask me. For more information consult a neurologist online --> </s>