Conversation: The conversation between human and AI assistant.
[|Human|] Hi. I am a 38 year old male who enjoys sports. I do a lot of weight training and I rum 3 km 3 times a week. For the last two years i have been having intermittent back pain in the lumbar region which usually settles with a few days of rest. Over the last 1 month however, the back pain seems to becoming more intense and longer lasting. 2 weeks ago after a 3 hour drive i gradually developed severe Left sided back pain radiating to the posterior part of the left thigh. An MRI taken the next day showed prolapsed disc involving L4-L5 and L5-S1. 2 days after that, i started having pins and needles over the posterior part of my left thigh and lateral part of left foot and weakness of my left calf . I was started on celebrex 400mg od and baclofen 1 tablet bd. Since then the pain has greatly subside. I would say 80% of the pain has dissappeared. The pins and needles and my calf weakness however has not improved. I can extend my foot but am completely unablen to tip toe . Can anyone suggest if surgery is indicated or can it still be treated conservatively? Do calf weakness return back to normal either with or without surgery? How long would it take to recover?
[|AI|]  Dear Patient, Diagnosis: PIED L4-5 & L5-S1 With LEFT L4 &L5 RADICALIZES & LEFT L4 & L5 RADICULOPATHY For your case, at the time of presentation, you could have been treated conservatively for 3 weeks with bed rest & symptomatic medications & no traction at all. Considering progressive neurodeficit viz. foot & toe affection & calf, you are a candidate for POSTERIOR DECOMPRESSION OF LEFT L4 & LEFT L5 NERVE ROOT & DISCECTOMY AT L4-L5 & L5-S1 LEVEL. With surgery, you can appreciate reversal of weakness & recovery sooner from first 24hrs of surgery up to 3 months similar to absolute conservative treatment algorithm of mine.  I wish you all the best.  Chat Doctor. S. Orthopedics & FELLOW IN SPINE SURGERY