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For further information, see CMDT Part 41-03: Spine Problems

Key Features

  • Pain is usually worse with back extension and relieved by sitting

  • Occurs in older patients (aged 50 years or older)

  • May present with neurogenic claudication symptoms with walking

Clinical Findings

  • Osteoarthritis in the lumbar spine can cause narrowing of the spinal canal

  • A large disk herniation can also cause stenosis and compression of neural structures or the spinal artery, resulting in "claudication" symptoms with ambulation

  • Pain that worsens with extension

  • Reproducible single or bilateral leg symptoms that are worse after walking several minutes and that are relieved by sitting (termed "neurogenic claudication")

  • Patients often exhibit limited extension of the lumbar spine, which may reproduce the symptoms radiating down the legs

  • Differential diagnosis

    • Claudication (arterial insufficiency)

    • Disk herniation

    • Lumbar facet joint degenerative arthritis

    • Sacroiliitis (eg, ankylosing spondylitis, epidural abscess or tumor, piriformis syndrome)


  • Thorough neurovascular examination is recommended (eTable 41–1)

eTable 41–1.Spine: back examination.


  • Flexion-based exercises demonstrated by a physical therapist can help relieve symptoms

  • Facet joint corticosteroid injections can also reduce pain symptoms

  • Epidural corticosteroid injections

    • Have been shown to provide immediate improvements in pain and function for patients with radiculopathy

    • However, the benefits are small and only short term

    • Consequently, there is limited evidence to recommend epidural corticosteroids for spinal stenosis


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