Neurogenic Claudication

Cramping from Spinal Stenosis

Depiction of a spine with spondylosis and facet joint hypertrophy
Facet joint hypertrophy may cause radiculopathy symptoms. Medical Art Inc./E+/Getty Images

Neurogenic Claudication

Neurogenic claudication is a syndrome, or collection of symptoms, associated with degenerative spinal stenosis in the lumbar spine. It is often related to posture. The combination of the stenosis with certain back postures such as arching puts pressure on lumbosacral nerve roots and/or the cauda equina. (The cauda equina -- which means horse's tail -- is a loose bundle of nerves resembling a tail.

The cauda equina extends below the main part of the spinal cord. The lumbosacral spine is located just above the cauda equina.)

Lumbar spinal stenosis is common in middle aged and elderly people; it generally takes a long time for the stenosis to develop and the symptoms of neurogenic claudication to appear.

Neurogenic Claudication Symptoms

Neurogenic claudication shows up as pain in the low back and leg. The pain may feel like muscle cramps. It is brought on during walking and/or extending the spine backwards (arching your back), and it is relieved by stooping, sitting, and/or bending forward at the waist.

Other symptoms include pins and needles going down your leg, and weakness. Bowel or bladder problems may occur if the neurogenic claudication is severe.

Neurogenic Claudication Treatment

Treatment for neurogenic claudication begins conservatively. Your doctor may prescribe pain medications and/or physical therapy.

If you are seeing a physical therapist for neurogenic claudication, it’s likely you’ll be given exercises that emphasize flexing your spine forward.

Other conservative treatments for lumbar spinal stenosis include modifying your activity, wearing a back brace or belt and/or having a spinal epidural injection to calm the pain.

If continued pain from neurogenic claudication greatly interferes with your lifestyle, it may be a sign that you need back surgery. Usually, a laminectomy (also known as decompression surgery) is the procedure given for spinal stenosis.

In a commentary in the January 6, 2010 issue of the Journal of the American Medical Association, Dr. Alexander Haig and his collegues asserted that reliable, across-the-board standards for diagnosing and conservatively treating lumbar spinal stenosis are lacking. This could mean that some doctors will use MRI, CT scans and/or EMG tests to diagnose your condition, while others may not. It could also mean that some doctors may be more likely to "push" you into back surgery without first giving conservative treatments a fair chance.

So do your research and talk to your doctor about all your options before deciding your course of action.

These standards called for in 2010 were still lacking in 2013, according to researchers of a systematic review published in Spine.

So far, they say, MRI offers the most promise for getting an accurate diagnosis. to patients. They suggest avoiding myelography because it's invasive.  Plus, myelography is not the most accurate test out there, the researchers say.  Electrodiagnostic tests don't compare to MRI for accuracy, either, they say.

The authors suggest that doctors consider using MRI and (and possibly the other tests mentioned) when patients present key symptoms relating to neurogenic claudication - as radiating leg pain made worse when you stand, an abatement of pain when you sit and improved symptoms when you bend forward and a wide gait.  

Sources:

Brunicardi, F. et.al. Schwartz’s Surgery. Chapter 41. Neurosurgery. Part II. Specific Considerations.. McGraw-Hill. Accessed Online: Access Medicine. May 2010.

Comer,C., et. al. Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists.BMC Musculoskeletal Disorders 2009, 10:121doi:10.1186/1471-2474-10-121

Andrew J. Haig, MD; Christy C. Tomkins, PhD. Diagnosis and Management of Lumbar Spinal Stenosis. JAMA. 2010;303(1):71-72.

Neurogenic Claudication. Mosby's Medical Dictionary. 7th edition. 2006. Elsevier. St. Louis, Mo.

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