What you need to know

• Suspect lumbar spinal stenosis in people over 50 who describe leg pain or paraesthesia on walking or prolonged standing, and who are walking reduced distances as a result

• Imaging is not required during initial assessment as the correlation between imaging findings and symptoms is poor

• Conservative treatment, which includes supervised exercise and manual therapy, is advised as first line treatment; about 30-50% of patients with mild to moderate symptoms experience spontaneous improvement in pain and ability to walk greater distances

• Prescribe pain medication only for a short period and after careful consideration, taking into account the important side effects, especially in older people, and the absence of good evidence for efficacy

• Refer patients with severe symptoms, neurological deficits, or no improvement after 3-6 months of conservative treatment to a spine specialist for imaging and further intervention or surgery