When should I refer a patient with lumbar spinal stenosis for surgical evaluation?

Patients with lumbar spinal stenosis should be referred for surgical evaluation when non-surgical treatments have failed to improve pain or function and their radiological findings are consistent with symptoms such as sciatica or neurogenic claudication.

Specifically, consider referral for spinal decompression surgery if the patient has persistent symptoms despite conservative management.

Urgent referral is indicated if there are signs of severe neurological compromise, such as new-onset bladder, bowel, or sexual dysfunction, or perineal numbness, which may suggest cauda equina syndrome.

Body mass index, smoking status, or psychological distress should not influence the decision to refer for surgical opinion.