Last reviewed: 16 Apr 2021
Last updated: 05 Oct 2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • onset and duration of symptoms
  • back pain
  • activity-related back pain
  • leg pain when walking
  • stooped posture when walking
  • leg numbness or paraesthesiae
  • absence of examination findings

Other diagnostic factors

  • pain radiating down the leg
  • bladder or bowel dysfunction
  • muscle weakness or wasting

Risk factors

  • age >40 years
  • manual labour
  • previous back surgery
  • family history of back pain
  • smoking
  • previous injury
  • achondroplasia
  • acromegaly

Diagnostic investigations

Treatment algorithm


Assistant Professor of Orthopaedic Surgery

Dartmouth-Hitchcock Medical Center




AMP is an author of a number of references cited in this topic.

Dr Adam M. Pearson would like to gratefully acknowledge Dr William A. Abdu, Dr John K. Houten, and Dr Mark Chwajol, previous contributors to this topic. WAA is an author of a reference cited in this topic. JKH and MC declare that they have no competing interests.

Peer reviewersVIEW ALL

Associate Professor

Department of Neurosurgery

Stanford University




JR declares that he has no competing interests.

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