Case history
Case history
A 65-year-old male retired builder has had lower back pain for 3 years. For the past 12 months he has been experiencing bilateral leg pain and a sense of heaviness in the legs when he is walking. The pain is relieved by bending over or sitting down. Over the past few months the distance he is able to walk has become progressively shorter and he has assumed a stooped posture. Physical examination is essentially unremarkable. Distal pulses are palpable and there is no appreciable weakness or muscle atrophy in the legs, or findings of hip or knee pathology.
Other presentations
Patients with a congenitally narrowed lumbar spinal canal present at a younger age. Rarely, patients present with symptoms of significant leg muscle weakness and atrophy or sphincter dysfunction, but this is unusual in the absence of substantial low back or leg pain. Symptoms of leg pain, numbness, and tingling upon standing or ambulation may be unilateral but more often are bilateral. Radiculopathy, characterised by pain radiating in a specific dermatomal pattern rather than causing symptoms of neurogenic claudication, is usually the result of stenosis in the lateral recesses and the neural foramina.
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