Neurogenic claudication in lumbar spinal stenosis is characteristically exacerbated by spinal extension (e.g., standing upright, walking) because extension further narrows the spinal canal. Conversely, symptoms are relieved by spinal flexion (e.g., sitting, leaning forward, squatting) as flexion increases the spinal canal diameter. Option A is incorrect; symptoms are often bilateral, and standing still typically worsens them. Option B is incorrect; walking uphill often involves more spinal flexion, which can be less symptomatic, while walking downhill or on flat ground (more extension) can worsen symptoms. Option D is incorrect; while back pain can be present, the defining feature of neurogenic claudication is leg pain, numbness, and weakness, often disproportionate to the back pain.
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