Global InformationNeurogenic claudication information
| Neurogenic Claudication | |
|---|---|
| Other names | Pseudoclaudication |
 | |
| CT scan of spinal stenosis and thickened ligamentum flavum, causing neurogenic claudication | |
| Specialty | Orthopedics, Neurology, Neurosurgery |
| Symptoms | Pain, tingling, tiredness, weakness, numbness or heaviness in the legs, hips, glutes and lower back. |
| Complications | Persistent pain in the lower body, difficulties standing, walking, exercising or performing general tasks, discomfort during sleep, bowel or bladder dysfunction |
| Causes | Lumbar spinal stenosis, osteoarthritis, spondylosis, rheumatoid arthritis, Paget's disease, spinal tumor, herniated or ruptured disks, scoliosis, trauma, achondroplasia |
| Risk factors | Age, obesity, previous spinal deformities or problems. |
| Diagnostic method | Physical examination, medical imaging (CT and X-Rays). |
| Differential diagnosis | Vascular claudication, trochanteric bursitis, piriformis syndrome, muscle pain, vertebral compression fracture, compartment syndrome, peripheral neuropathy, Lumbar radicular syndrome (lumbar radiculopathy) and pain in other spinal structures: hip, myofascia, sacroiliac joint |
| Treatment | Physical therapy, medications, surgery |
| Medication | Non-steroidal anti-inflammatory drugs, prostaglandin-based drugs, gabapentin, methylcobalamin, epidural injections, lidocaine and steroids |
Neurogenic claudication (NC), also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis (LSS) and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord.[1][2] Neurogenic means that the problem originates within the nervous system. Claudication, from the Latin word for to limp, refers to painful cramping or weakness in the legs.[3] NC should therefore be distinguished from vascular claudication, which stems from a circulatory problem rather than a neural one.
The term neurogenic claudication is sometimes used interchangeably with spinal stenosis. However, the former is a clinical term, while the latter more specifically describes the condition of spinal narrowing.[4] NC is a medical condition most commonly caused by damage and compression to the lower spinal nerve roots.[5] It is a neurological and orthopedic condition that affects the motor nervous system of the body, specifically, the lower back, legs, hips and glutes.[5][6] NC does not occur by itself, but rather, is associated with other underlying spinal or neurological conditions such as spinal stenosis or abnormalities and degenerative changes in the spine. The International Association for the Study of Pain defines neurogenic claudication as, "pain from intermittent compression and/or ischemia of a single or multiple nerve roots within an intervertebral foramen or the central spinal canal.[4] This definition reflects the current hypotheses for the pathophysiology of NC, which is thought to be related to the compression of lumbosacral nerve roots by surrounding structures, such as hypertrophied facet joints or ligamentum flavum, bone spurs, scar tissue, and bulging or herniated discs.[7]
The predominant symptoms of NC involve one or both legs and usually presents as some combination of tingling, cramping discomfort, pain, numbness, or weakness in the lower back, calves, glutes, and/or thighs and is precipitated by walking and prolonged standing. However, the symptoms vary depending on the severity and cause of the condition. Lighter symptoms include pain or heaviness in the legs, hips, glutes and lower back, post-exercise.[6][8] Mild to severe symptoms include prolonged constant pain, tiredness and discomfort in the lower half of the body.[6][8] In severe cases, impaired motor function and ability in the lower body can be observed, and bowel or bladder dysfunction may be present.[6][8] Classically, the symptoms and pain of NC are relieved by a change in position or flexion of the waist.[9] Therefore, patients with NC have less disability in climbing steps, pushing carts, and cycling.[1]
Treatment options for NC depends on the severity and cause of the condition, and may be nonsurgical or surgical. Nonsurgical interventions include drugs, physical therapy, and spinal injections.[10] Spinal decompression is the main surgical intervention and is the most common back surgery in patients over 65.[1] Other forms of surgical procedures include: laminectomy, microdiscectomy and laminoplasty.[8][11] Patients with minor symptoms are usually advised to undergo physical therapy, such as stretching and strengthening exercises. In patients with more severe symptoms, medications such as pain relievers and steroids are prescribed in conjunction with physical therapy. Surgical treatments are predominantly used to relieve pressure on the spinal nerve roots and are used when nonsurgical interventions are ineffective or show no effective progress.[1][11]
Diagnosis of neurogenic claudication is based on typical clinical features, the physical exam, and findings of spinal stenosis on Computer Tomography (CT) or X-Ray imaging.[1] In addition to vascular claudication, diseases affecting the spine and musculoskeletal system should be considered in the differential diagnosis.[9]
- ^ a b c d e Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK (December 2019). "A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis". Pain Medicine. 20 (Suppl 2): S32–S44. doi:10.1093/pm/pnz161. PMC 7101166. PMID 31808530.
- ^ Lee SY, Kim TH, Oh JK, Lee SJ, Park MS (October 2015). "Lumbar Stenosis: A Recent Update by Review of Literature". Asian Spine Journal. 9 (5): 818–28. doi:10.4184/asj.2015.9.5.818. PMC 4591458. PMID 26435805.
- ^ Pearce JM (2005). "(Neurogenic) Claudication". European Neurology. 54 (2): 118–9. doi:10.1159/000088648. PMID 16408366.
- ^ a b Vining RD, Shannon ZK, Minkalis AL, Twist EJ (November 2019). "Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations". Journal of Manipulative and Physiological Therapeutics. 42 (9): 651–664. doi:10.1016/j.jmpt.2019.08.002. PMID 31870637.
- ^ a b Kobayashi S (April 2014). "Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis". World Journal of Orthopedics. 5 (2): 134–45. doi:10.5312/wjo.v5.i2.134. PMC 4017306. PMID 24829876.
- ^ a b c d Alvarez JA, Hardy RH (April 1998). "Lumbar spine stenosis: a common cause of back and leg pain". American Family Physician. 57 (8): 1825–34, 1839–40. PMID 9575322.
- ^ Lurie J, Tomkins-Lane C (January 2016). "Management of lumbar spinal stenosis". BMJ. 352: h6234. doi:10.1136/bmj.h6234. PMC 6887476. PMID 26727925.
- ^ a b c d Critchley E, Eisen A (1992). "Disc and Degenerative Disease: Stenosis, Spondylosis and Subluxation". In Swash M (ed.). Clinical Medicine and the Nervous System. Hong Kong: Springer London. pp. 157–180. ISBN 978-1-4471-3353-7.
- ^ a b Suri P, Rainville J, Kalichman L, Katz JN (December 2010). "Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis?". JAMA. 304 (23): 2628–36. doi:10.1001/jama.2010.1833. PMC 3260477. PMID 21156951.
- ^ Messiah S, Tharian AR, Candido KD, Knezevic NN (March 2019). "Neurogenic Claudication: a Review of Current Understanding and Treatment Options". Current Pain and Headache Reports. 23 (5): 32. doi:10.1007/s11916-019-0769-x. PMID 30888546. S2CID 83464182.
- ^ a b Gala RJ, Yue JJ (2018). Reach J, Yue JJ, Narayan D, Kaye A, Vadivelu N (eds.). Perioperative Pain Management for Orthopaedic and Spine Surgery. United States: Oxford University Press. pp. 172–186. doi:10.1093/med/9780190626761.001.0001. ISBN 9780190626761.