Review Question - QID 218230

A 76-year-old female presents with worsening back pain and bilateral lower extremity neurogenic claudication that has progressively worsened over the last 2 years. Additionally, she feels as if she is having increasing difficulty standing fully erect which makes it difficult for her to walk meaningful distances. Her back pain, posture issues, and neurogenic claudication are all equally bothersome. She has tried alleviating her symptoms with physical therapy, epidural steroid injections, and a monitored opioid regimen with pain management but has not achieved lasting relief. She has a history of osteoporosis that is currently treated with alendronate for the last 4 years. Her most recent DEXA was significant for a T-score of -3.2 in the left femoral neck. The patient is now considering surgical treatment for her symptoms. Which of the following is the most appropriate next step in treatment?