From the Research
Definition and Diagnosis
- Neurogenic claudication is a condition characterized by leg pain or discomfort that occurs when walking or exercising, and is relieved by rest 1, 2.
- It is often associated with lumbar canal stenosis (LCS) 2, 3.
- The diagnosis of neurogenic claudication is based on a classical history and complementary spinal imaging, and should be distinguished from intermittent claudication (peripheral vascular disease), referred pain from the back or root pain that is aggravated by walking, and psychological distress 2.
Causes and Pathology
- Neurogenic claudication can be caused by a developmentally small canal affected by multiple levels of segmental degenerative change, with venous pooling in the cauda equina between two levels of low pressure stenosis 2.
- Vasculitis in the cauda equina can also cause neurogenic claudication, as seen in a rare case of microscopic polyangiitis (MPA) 3.
- Coexisting cervical and lumbar spinal stenosis can also lead to neurogenic claudication, with patients presenting with radiculopathy in their upper and lower extremities 4.
Treatment and Management
- Conservative management is reasonable for neurogenic claudication, but decompression at the most significant stenotic level may be necessary to obtain a good surgical result 2.
- Nonoperative treatment options, such as calcitonin, prostaglandins, gabapentin, and epidural steroid injections, have shown varying degrees of effectiveness in improving walking distance, pain, and function 5.
- Exercise and multimodal nonoperative treatment may also be beneficial, but high-quality evidence is lacking to guide clinical practice 5.
Neurogenic Claudication of the Upper Extremities
- There is limited information available on neurogenic claudication of the upper extremities, as most studies focus on the lower extremities 1, 2, 3, 4, 5.
- However, coexisting cervical and lumbar spinal stenosis can lead to radiculopathy in both the upper and lower extremities, suggesting that neurogenic claudication can occur in the upper extremities as well 4.