Neurogenic Claudication

Neurogenic = arising in the nervous system
Claudication= leg pain, heaviness and/or weakness with walking

Neurogenic claudication results from compression of the spinal nerves in the lumbar (lower) spine. It is sometimes known as pseudoclaudication.

Neurogenic claudication is different from vascular claudication, sometimes simply called claudication, which is caused by impaired blood flow to the leg muscles.

The symptoms of neurogenic claudication can include pain, tingling, or cramping in the lower back and one or both legs, hips, and buttocks. Weakness or heaviness in the legs may also occur. These symptoms are especially present when standing upright or walking and usually relieved with leaning forward or sitting down.

Neurogenic claudication is usually caused by spinal stenosis (narrowing of the spinal canal) in the lumbar spine (lower back). The narrowing of the spinal canal is generally caused by wear and tear and arthritic changes in the lower spine. These changes include bulging discs, thickening of ligaments, and overgrowth of bone spurs, especially at spinal facet joints. Stenosis can compress the nerve roots that control sensation and movement in the lower body. This compression causes the pain, tingling, or cramping.

The pain is usually worse when standing and walking because in a fully upright posture, the spinal canal naturally narrows, placing additional pressure on the nerve roots. The pain can often be temporarily relieved by sitting down or flexing forward– in these postures, the spinal canal naturally expands a bit, relieving the excess pressure on the nerve roots.

A full physical exam and detailed interview will help a physician determine the type of pain and its origin. Certain symptoms can help a physician distinguish neurogenic claudication from vascular claudication–for example, the pain of vascular claudication is often relieved simply by rest, while pain due to neurogenic claudication is best relieved by bending forward or sitting down.

Various imaging studies can confirm a diagnosis of neurogenic claudication and help determine the if the cause is spinal stenosis. These studies include:

• X-ray (also known as plain films) –test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones. Soft tissue structures such as the spinal cord, spinal nerves, the disc and ligaments are usually not seen on X-rays, nor on most tumors, vascular malformations, or cysts. X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, as well as local and overall spine balance can be assessed with X-rays. Specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion can also be identified on plain film X-rays. Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.
• Magnetic resonance (MR) imaging– a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of soft tissues and bones. MR imaging scans can reveal whether the stenosis is due to a bulging or herniated disc.
• Computed tomography (CT) scan– a diagnostic imaging procedure that uses a computer and X-rays to produce images of bones and soft tissues.

In general, the goal of surgical treatment is to decompress (remove the pressure from) the nerve roots in the lumbar spine. If the compression results from a herniated disc, a microdiscectomy (procedure that uses small incisions with a tiny video camera for viewing) may provide relief. In other cases, a laminectomy (removal of part of a bone) may be necessary. Dr. McCormick and his team can determine the best treatment for each case.

Drs. Paul McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. Mandigo, Patrick C. Reid and Richard C.E. Anderson (Pediatric) are experts in treating neurogenic claudication. Each can also offer you a second opinion.