Last reviewed: 27 Dec 2021
Last updated: 14 Dec 2021



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
  • diabetes mellitus
  • peripheral vascular occlusive disease
  • previous injury
  • achondroplasia
  • acromegaly

Diagnostic investigations

Investigations to consider

  • CT myelography
  • CT spine
  • electromyographic (EMG) walking test
  • electromyographic paraspinal mapping

Treatment algorithm



Michael David Tseng MD, MD

Clinical Assistant Professor

Department of Orthopaedic Surgery

Stanford University School of Medicine




MDT declares that he has no competing interests.


Dr Michael David Tseng would like to gratefully acknowledge Dr Adam M. Pearson, 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.


WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.

Peer reviewers

John Ratliff, MD, FAANS, FACS

Associate Professor

Department of Neurosurgery

Stanford University




JR declares that he has no competing interests.

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