Lumbar spinal stenosis often presents with neurogenic neurogenic claudication (NC) (claudicate: from Latin, claudico, to limp) AKA pseudoclaudication. To be differentiated from vascular claudication (AKA intermittent claudication), which results from ischemia of exercising muscles

Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing and walking that is relieved by sitting or lying (neurogenic claudication)

● symptoms differentiated from vascular claudication which is usually relieved at rest regardless of position

Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication.

Lumbar spinal stenosis (LSS) or peripheral vascular disease (PVD)

The most sensitive symptom attribute to rule out LSS was the absence of “triggering of pain with standing alone” (sensitivity 0.97, NLR 0.050). Pain alleviators and symptom location data showed a weak clinical significance for LSS and PVD. Constellation of symptoms yielded the strongest associations: patients with a positive shopping cart sign whose symptoms were located above the knees, triggered with standing alone and relieved with sitting had a strong likelihood of neurogenic claudication (PLR 13). Patients with symptoms in the calf that were relieved with standing alone had a strong likelihood of vascular claudication (PLR 20.0).

The classic symptom attributes used to differentiate neurogenic from vascular claudication are at best weakly valid independently. However, certain constellation of symptoms are much more indicative of etiology. These results can guide general practitioners in their evaluation of and investigation for claudication 1).

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.
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