01PresentationThe clinical pattern matters more than the word stenosis on a report.+
- Neurogenic claudication: leg/buttock symptoms provoked by standing or walking and relieved by sitting or flexion.
- Radicular pain, paresthesia, weakness, and reduced walking tolerance may coexist; axial pain alone is less specific.
- Screen every visit for progressive deficit and cauda equina features.
02WorkupDefine neural compression, stability, and competing diagnoses.+
- MRI characterizes central, lateral recess, and foraminal narrowing.
- Standing and flexion-extension radiographs can assess alignment or instability when the result changes management.
- Consider vascular claudication, hip disease, neuropathy, and deconditioning when symptoms and imaging conflict.
03ManagementMost surgery is elective unless deficit or CES changes the timeline.+
- Begin individualized activity modification, exercise-based rehabilitation, medication, or injection options when stable.
- Consider decompression for persistent function-limiting symptoms despite reasonable nonoperative care.
- Fusion depends on instability, deformity, or planned bony resection—not stenosis alone.
