Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic low back pain associated with neurogenic claudication. Symptoms are characterized by bilateral radicular pain, paresthesia, and heaviness in the lower extremities, exacerbated by prolonged standing or walking and significantly relieved by forward flexion (shopping cart sign) or sitting. No bowel or bladder dysfunction reported.
Clinical Examination Findings
Lumbar spine examination reveals restricted range of motion in extension. Palpation demonstrates paraspinal muscle tenderness. Neurological exam: motor strength 5/5 in bilateral lower extremities, sensation intact to light touch in L2-S1 dermatomes. Deep tendon reflexes are symmetric but may be diminished. Positive Kemp’s test for facet loading; negative straight leg raise (SLR). Gait is stable but may show a stooped posture.
Treatment Protocol
Conservative management initiated: physical therapy focusing on core stabilization and flexion-based exercises. Pharmacological intervention includes NSAIDs and/or gabapentinoids for neuropathic pain. Consider epidural steroid injections (ESI) if symptoms persist. Patient advised on activity modification and weight management. Surgical consultation for decompression (laminectomy) reserved for refractory cases.