A 50-year-old woman presented with a one year history of back and leg pain. The leg pain occurred with exercise, and was slow to resolve with rest, consistent with neurogenic claudication. Peripheral vascular examination was normal. Sagittal MRI of the lumbar spine showed multi-level degenerative joint disease, worst at L4-5, A central disk herniation at L4-5, and spinal canal stenosis between L3 and S1.