What symptom has the best utility in diagnosing lumbar spinal stenosis?

• A. Sitting increases pain
• B. Symptoms that are abolished with sitting
• C. Leg pain with standing
• D. Worsening pain with extension

Answer: (B)

The symptom that has the best utility in diagnosing lumbar spinal stenosis is characterized by symptoms that are abolished with sitting. This is particularly indicative of lumbar spinal stenosis because the condition involves narrowing of the spinal canal, which can put pressure on the spinal cord and nerve roots, leading to pain and discomfort during activities that require standing or walking.

When a patient with lumbar spinal stenosis sits, the flexed position often relieves nerve root compression and decreases pain, illustrating a typical finding in this condition. This relief of symptoms upon sitting can be a strong diagnostic indicator, as it contrasts with other spine-related issues where pain may worsen with flexion or sitting still.

In contrast, while symptoms like leg pain with standing may be common among patients with lumbar spinal stenosis, they may not be unique to this condition and can overlap with other causes of back pain. Similarly, worsening pain with extension is also relevant but more associated with conditions like spondylolisthesis or facet joint syndrome rather than lumbar spinal stenosis specifically.

Thus, the feature of symptoms that are relieved by sitting is crucial for differentiating lumbar spinal stenosis from other lumbar pathologies, making it a key symptom for diagnosis.