<s>[INST] I am 56 yr old female and have been diagnosed with moderate discogenic and spondylotic changes in the lower 2 lumbar levels greatest at L4-5 where there is a grade 1 degenerative listhesis with rather severe central canal and lateral recess narrowing bilaterally. there is broad-based posterior disc protrusion at this level. There is moderate left and mild right foraminal narrowing. Also at L5-S1 there is facet arthropathy w/a broad based right paracentral and foraminal disc protrusion w/moderate right lateral recess and mild right foraminal narrowing. Left neural foramen and left lateral recess and mild narrowing. There is overall mild facet overgrowth at L3-4 with mild central canal and lateral recess narrowing. Question: Will I need surgery? [/INST] I read your question carefully, and I understand your concern. The decision to undergo surgery though is not taken solely on your imaging results but also on what symptoms do they cause and their intensity. Also, usually conservative treatment and physiotherapy is always tried for some months first. If you have intense pain which hasn't responded to physical therapy then I believe surgery for the changes in L4-L5 with severe canal and lateral recess narrowing. At time if the symptoms do not correspond to compression at this level nerve conduction studies are done beforehand to make sure which level needs to be ad Chat Doctor. I hope to have been of help. </s>