Resting in a standing position is usually not sufficient, or may even aggravate the pain. In contrast, the pain of vascular insufficiency is usually immediately relieved by resting in a standing position. This is a key distinguishing feature. Sensory loss is also dermatomal, whereas with vascular insufficiency it is in a stocking-glove distribution. Lumbosacral spine X-rays are taken to assess alignment and the diameter of the canal.
Oblique films help to evaluate the foramina and the presence of pars defects.
CT scan is excellent in showing the shape and dimensions of the canal, ligamentum flavum hypertrophy, facet arthropathy, and disc bulges and herniation. CT may be plain or following myelography. MRI has significant limitations in defining bone detail, but is good in defining root impingement and foraminal narrowing. Surgery for decompression is indicated when conservative measures fail to provide a level of relief which is appropriate or desired by the patient. This must be individualized for each patient.