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Select neurogenic claudication from a thick flavum
The indication is a symptom pattern plus a specific cause on imaging.
Risks and benefits
Intended benefit
The intended outcome is longer walking and standing with less leg pain and disability in neurogenic claudication from central stenosis with a thick flavum. In open-label randomized trials mild did better than epidural steroid and than usual care alone; there is no sham-controlled trial.
Risks and tradeoffs
Discuss dural tear with CSF leak, epidural haematoma, nerve injury, infection and failure to relieve symptoms. Claims data show fewer harms than spacers or laminectomy but more later surgery than laminectomy.
Make the decision together
Compare continued conservative care, epidural steroid, spacers and open or minimally invasive surgery. Explain which part of the stenosis mild treats, what the evidence shows, and that the trials were manufacturer-sponsored.