From the Guidelines
Neurologic claudication and vascular claudication are two distinct conditions with different underlying causes and presentations, and accurate diagnosis is crucial for appropriate treatment. The main difference between neurologic claudication and vascular claudication lies in their underlying causes and symptoms. Neurologic claudication, typically caused by spinal stenosis, presents with bilateral leg pain, numbness, and weakness that worsens with walking or standing, and is often relieved by sitting or leaning forward 1. In contrast, vascular claudication, resulting from peripheral artery disease, causes cramping pain in the muscles, usually in one leg, that predictably occurs after walking a certain distance, and is relieved by stopping and resting, regardless of position 1.
Key Differences
- Neurologic claudication is often accompanied by back pain and improves with spinal flexion, while vascular claudication is associated with cool, pale skin and diminished pulses in the affected limb 1.
- The location of pain also differs: neurologic claudication often affects the buttocks, thighs, and sometimes calves, whereas vascular claudication typically starts in the calf muscles 1.
- Vascular claudication is a manifestation of peripheral artery disease, which affects 3% to 7% of the general population and 20% of people >70 years of age 1.
- Neurologic claudication, on the other hand, is often caused by spinal stenosis, and its symptoms can be relieved by surgical or non-surgical interventions aimed at relieving spinal compression 1.
Diagnostic Approach
- Noninvasive hemodynamic tests such as the ankle brachial index, toe brachial index, segmental pressures, and pulse volume recordings are considered the first diagnostic modalities necessary to reliably establish the presence and severity of arterial obstructions 1.
- Imaging studies of the lumbar spine or soft tissues of the pelvis may be indicated in the absence of demonstrable arterial disease 1.
- Accurate diagnosis and differentiation between neurologic and vascular claudication are essential for appropriate treatment and management, as management strategies differ significantly between the two conditions 1.
From the Research
Difference between Neurologic Claudication and Vascular Claudication
The main difference between neurologic claudication and vascular claudication lies in their underlying causes and symptoms.
- Neurologic claudication, also known as neurogenic claudication, is caused by compression of the spinal nerves, typically due to spinal stenosis 2, 3, 4.
- Vascular claudication, also known as intermittent claudication, is caused by insufficient blood flow to the muscles, usually due to peripheral artery disease (PAD) 3, 5, 4, 6.
Symptoms
The symptoms of neurologic claudication and vascular claudication can be distinguished as follows:
- Neurologic claudication: symptoms include pain, numbness, or weakness in the legs, which can be triggered by standing or walking and relieved by sitting or leaning forward 2, 3, 4.
- Vascular claudication: symptoms include crampy pain in the calf or leg, which is triggered by exercise and relieved by rest 5, 6.
Diagnosis
A thorough history and physical examination are necessary to distinguish between neurologic claudication and vascular claudication 2, 3, 5, 4, 6.
- Diagnostic tests such as ankle-brachial index, Doppler testing, and spinal imaging can also be used to confirm the diagnosis 5, 6.
Treatment
Treatment for neurologic claudication and vascular claudication differs:
- Neurologic claudication: treatment options include conservative management, decompression surgery at the most significant stenotic level 2.
- Vascular claudication: treatment options include non-pharmacological treatment, pharmacological treatment, and interventional treatment, such as supervised exercise programs, cilostazol, and angioplasty 5.