The purpose of this study is to demonstrate using three case studies the challenges when presented with an elderly patient who presents with back pain, lower extremity symptoms, and limited walking ability. The ability to accurately diagnose DLSS and the various other conditions that give rise to similar symptoms and limitations is paramount for appropriate treatment. 4, 5 Often more than one condition can be present at the same time which makes diagnosis even more challenging. 4 There are many other common conditions in the elderly that also give rise to lower extremity symptoms and limited walking ability. Limited walking ability is the dominant functional impairment caused by DLSS. Lower back pain is not necessarily associated with neurogenic claudication. It is characterized by bilateral or unilateral buttock, lower extremity pain, heaviness, numbness, tingling or weakness, precipitated by walking and standing 3 and relieved by sitting and bending forward 4, 5. 2 The clinical syndrome of DLSS is known as neurogenic claudication. It is a chronic disease caused by age related degenerative narrowing (stenosis) of the spinal canal that can lead to compression and ischemia of the spinal nerves (neuroischemia). 1 The prevalence and economic burden of DLSS is growing exponentially due to the aging population. Degenerative lumbar spinal stenosis (DLSS) is a leading cause of pain, disability, and loss of independence in older adults.
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