Intermittent 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

Intermittent neurogenic claudication is one of two main types of leg cramping associated with the act of walking.  "Neurogenic" refers to the fact that symptoms arise when nerves that get impinged in cases of lumbar spinal stenosis. The other type of intermittent claudication — intermittent vascular claudication is usually due to peripheral vascular disease (PVD.)  

Chances are, both types intermittent claudication will side rail, at least to some degree, your plans for being active, but the way in which each accomplishes this is different.

With vascular claudication, blood vessels narrow to the point where the amount of blood that flows through them is not enough to meet the demands of your lower extremity. In cases of neurogenic claudication, your lumbar spine (low back) stays in an extended position for an extended period of time. This, in turn, narrows either your spinal canal or your neuroforamen to the point where the sensitive nerve tissue that normally passes through unimpeded becomes compressed by the nearby bone.

Neurogenic Claudication Symptoms

Neurogenic claudication is actually a syndrome, or a collection of symptoms. It is related to posture and may show up as pain in the low back and/or leg as muscle cramps. The combination of the spinal 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.)

Symptoms of intermittent neurogenic claudication are often brought on by walking and/or extending the spine backwards (again, arching your back,) and relieved by stooping, sitting, and/or bending forward at the waist.

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

Because lumbar spinal stenosis develops over time, and not as a result of a one-time incident, symptoms  tend to take a while before they are noticeable, as well.

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. The North American Spine Society says that a series of spinal epidurals injections (with steroid medication) may help to relieve pain from intermittent neurogenic claudication (as well as radiculopathy) in the medium term.

They define the medium term as 3-36 months.

If continued pain from intermittent 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. Discuss your options with your doctor to be sure.

In a commentary in the January 6, 2010 issue of the Journal of the American Medical Association, Dr. Alexander Haig and his colleagues 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 chance. So do your research and talk to your doctor about all your options before deciding what to do.

Source:

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.

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

Nadeau, M., M.D. The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation. Can J Surg. Dec. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859778/

North American Spine Society (NASS). Diagnosis and treatment of degenerative lumbar spinal stenosis. Burr Ridge (IL): North American Spine Society (NASS); 2011.

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