Ambulation-induced pain localized to the calf and distal lower extremity resolving with sitting or leaning forward (pseudoclaudication or "neurogenic dlaudication) is a hallmark of lumbar spinal stenosis. Other symptoms of lumbar spinal stenosis can include back pain and seensory loss and weakness in the legs, though many patients may present with a normal neurologic exam. Symptoms of neurogenic dlaudication can usually be distinguished from vascular claudication (table 5). Rare patients develop a cauda equina syndrome. Patients often have symptoms only when active. Most patients with spinal stenosis related to osteoarthritis will have stable symptoms over time. A trial of conservaive, nonsurgical treatment is the initial therapy for most patients [26]. (See "Lumbar spinal stenosis: Pathopbysiology.clinicalieatures.and MasusA2EGIOn on Clinical presentation and "Lumbar spinal stenosis: Treatment and prognosis", section on 'Prognosis' and "LumbarSRInal stenosis: Treatment and prognosis", section on 'Nonsurgical treatment.)