Lumbar Stenosis

Symptoms

Patients often describe leg pain, heaviness, numbness, or weakness that increases with standing and walking and eases with sitting or leaning forward. Back pain may or may not be prominent.

Diagnosis

The history establishes the walking pattern and functional limit. Examination evaluates strength, sensation, reflexes, pulses, hips, and gait; MRI and standing X-rays define compression, alignment, and stability.

Treatment options

Initial treatment may include medication, flexion-tolerant conditioning, physical therapy, activity modification, and selected epidural injections. The objective is to improve walking and daily function.

When surgery is considered

Decompression is considered when walking and quality of life remain substantially limited, neurologic deficits progress, and imaging identifies a target. Fusion is added only when instability, deformity, or reconstruction needs justify it.

When to seek care promptly

Seek prompt care for progressive weakness, foot drop, or new bowel or bladder difficulty.