Algorithmic approach to the management of the patient with lumbar spinal stenosis.

A 71-year-old generally healthy woman presents for her first visit in 3 years. She ambulates slowly from the waiting room, with a more stooped posture than previously. She reports a 2-year history of slowly worsening buttock and leg pain when she walks any distance. She has noticed that her symptoms are much less when she leans on a shopping cart in the grocery store. Her buttock/leg pain resolves within a few minutes when she sits down. The patient exhibits signs and symptoms suggestive of lumbar spinal stenosis.