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Which of the following procedures has been found to lead to accelerated disc degeneration and the development of reactive endplate changes?
Lumbar transforaminal epidural steroid injections
Lumbar spinal anesthesia
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A 45-year-old construction worker presents to your office with a chief complaint of 3 weeks of low back pain. He states the pain started while he was at work and he now has a difficult time working a full day. He reports the pain is worse with activity but he cannot describe any certain positions that make it worse. He denies any recent history of fever, night sweats, or weight loss. He reports normal bowel and bladder function and denies symptoms radiating into his buttocks or legs. On physical exam he has 5/5 strength in his lower extremities, a normal sensory and reflex exam. Forward flexion of the lumbar spine elicits pain in his lower back. He is able to touch his knees when bending forward, but is unable to touch his toes secondary to pain. What is the most appropriate next step in management?
Lumbar spine x-rays
Lumbar spine MRI
Oral methylprednisoline taper
Physical therapy and NSAIDs