Results for mri l4 l5 say: facet arthropathy moderate. left paracentral focal disc protrusion posteriorly 8mm high grade narrowing. surgery or rehab?

It depends: Almost every 45+ yo has these sort of findings on MRI which may not necessarily correlate with what is causing pain as many post-surgical pts find and 45 is young to do sgy. However, the correct answer is, depends on symptoms. If you are getting foot drop and nerve damage, surgery is better otherwise for pain, try rehab first and defer surgery for when you are a bit older and really worse off.