Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic low back pain associated with neurogenic claudication. Symptoms are characterized by bilateral lower extremity heaviness, paresthesia, and cramping, exacerbated by standing or walking and significantly relieved by forward flexion (shopping cart sign) or sitting. No history of bowel or bladder incontinence.
Clinical Examination Findings
Lumbar spine examination reveals restricted range of motion in extension. Neurological exam: motor strength 5/5 in all major muscle groups of lower extremities, sensation intact to light touch. Deep tendon reflexes are symmetric but may be diminished at the patellar or Achilles levels. Positive Kemp’s test in extension. Gait is stable but may show a wide-based, cautious pattern.
Treatment Protocol
Conservative management initiated: physical therapy focusing on core stabilization and flexion-based exercises. Pharmacological intervention includes NSAIDs and neuropathic pain modulators (e.g., gabapentinoids). Consider epidural steroid injections for radicular symptoms. Surgical consultation for decompression (laminectomy) if symptoms are refractory to conservative care or if neurological deficits progress.