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neurogenic_claudication

Neurogenic claudication

Intermittent neurogenic claudication (INC) caused by severe lumbar spinal stenosis (LSS) is common in the elderly 1) 2) 3).

Differential diagnosis

An extended lumbar posture narrows a degenerative stenotic spinal canal to a critical threshold, leading to direct mechanical compression or indirect vascular compression of the nerve roots and/or cauda equina 4) 5).

The location of the symptoms (above the knees for neurogenic claudication; below the knees for vascular claudication) as well as the symptom alleviators (sitting for neurogenic claudication; standing for vascular claudication). However, alleviation of symptoms with standing alone has a moderate correlation with vascular claudication; its presence could direct physicians toward a vascular workup rather than neurogenic investigations.

Certain constellations of symptom attributes are more strongly associated with each type of claudication.

The presence of symptoms that are triggered with standing, relieved with sitting, located above the knees and have a positive shopping cart sign represent strong evidence that a patient has intermittent neurogenic claudication rather than vascular claudication. On the other hand, a patient with symptoms that are relieved with standing alone and located below the knees is much more likely to have vascular than neurogenic claudication 6).

1)
Evans JG. Neurogenic intermittent claudication. Br Med J. 1964;2(5415):985–987. doi: 10.1136/bmj.2.5415.985.
2)
Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M. Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama spine study. Osteoarthr Cartil. 2012;20(10):1103–1108. doi: 10.1016/j.joca.2012.06.018.
3)
Verbiest H. Primary stenosis of the lumbar spinal canal in adults, a new syndrome. Ned Tijdschr Geneeskd. 1950;94(33):2415–2433.
4)
Wilson CB. Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. J Neurosurg. 1969;31:499–506.
5)
Epstein NE, Maldonado VC, Cusick JF. Symptomatic lumbar spinal stenosis. Surg Neurol. 1998;50:3–10.
6)
Nadeau M, Rosas-Arellano MP, Gurr KR, Bailey SI, Taylor DC, Grewal R, Lawlor DK, Bailey CS. The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation. Can J Surg. 2013 Dec;56(6):372-7. PubMed PMID: 24284143; PubMed Central PMCID: PMC3859778.
neurogenic_claudication.txt · Last modified: 2016/05/17 13:47 (external edit)