A 45-year-old male with L5-S1 degenerative spondylolisthesis (Grade II) has failed 6 months of conservative management, including physical therapy, NSAIDs, and epidural injections. He continues to experience severe radicular pain in his left leg, significantly impacting his quality of life. Neurological examination reveals mild weakness in the left extensor hallucis longus. What is the most appropriate next step in management?

Explanation

This patient has failed extensive conservative management for a symptomatic Grade II degenerative spondylolisthesis with persistent radicular pain and objective neurological deficit (mild weakness in the left extensor hallucis longus, indicating L5 nerve root involvement). These are strong indications for surgical intervention. Surgical decompression (to relieve nerve root compression) and fusion (to stabilize the segment and prevent further slippage) are commonly performed in such cases. Continuing conservative management or trying alternative therapies like chiropractic manipulation are unlikely to be effective given the failure of previous treatments and the presence of neurological signs. A lumbar brace might offer temporary relief but is not a definitive solution for persistent radiculopathy and failed conservative care.