She has no motor weakness but loss of pinprick sensation around her medial malleolus and great toe, with loss of vibration sensation in her great toe also. She is unsteady on walking, with a wide based gait and has a abnormal Romberg’s sign. Her MRI scan shows spinal stenosis around the level of L4-L5 from a combination of osteophytes and spondylolisthesis.
What is your initial management plan?
