Definition
Neurogenic claudication is leg pain, heaviness, paraesthesia or weakness caused by lumbar spinal canal narrowing and neural compression, usually in degenerative lumbar spinal stenosis.
Typical history
- worse with standing and walking
- worse with lumbar extension
- relieved by sitting or lumbar flexion
- patients may report relief when leaning over a shopping trolley
Symptoms can be unilateral or bilateral.
Neurogenic versus vascular claudication
Neurogenic
- posture dependent
- relief with sitting or flexion
- pulses usually preserved
- neurological symptoms may coexist
Vascular
- related mainly to exertional distance
- may improve simply by stopping
- reduced pulses or trophic vascular signs may be present
Examination
Examination may be normal at rest. Assess gait, lumbar motion, neurological function, pulses and hip pathology.
Imaging
- standing AP and lateral radiographs
- flexion/extension views when instability is suspected
- MRI is the principal investigation for neural compression
Treatment
Initial management includes activity modification, analgesia and physiotherapy. Surgery is considered for persistent disabling symptoms or neurological deterioration after appropriate non-operative care.