unsteady, shuffling, and spastic. This is because lumbar encroachment may result in both abnormal proprioception (with sensory ataxia) and spasticity. Hence, the slow, unsteady, and yet stiff gait of spinal stenosis. The diagnosis should be suspected in older patients with severe lower-extremity pains that resolve on sitting. Thigh pain after 30 seconds of lumbar extension is also a good predictor. Neurologically,
there is usually an abnormal Romberg’s sign (inability to stand with feet together and eyes closed for more
than 60 seconds), abnormal Achilles reflex, decreased strength (of knee flexors and extensors, ankle
dorsiflexors and plantar flexors, and extensor hallucis longus muscle), and dorsal column signs (vibration and
weakened pinprick). Difficulties with sphincter control can also be present, but only in 20% of the cases.