Neurogenic Claudication and Spinal Stenosis

Neurogenic claudication occurs when nerves in the lower spine become compressed. Also known as pseudoclaudication, it is a classic symptom of lumbar spinal stenosis—a condition in which passageways in the spinal column become narrowed by bone spurs or other abnormal structures.

Neurogenic claudication should not be confused with vascular claudication, which is a condition that involves the arteries in the legs or arms.

Spinal stenosis often affects seniors and the elderly.
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Two Types of Claudication

Intermittent neurogenic claudication is one of two main types of leg cramping that are associated with the act of walking.

Chances are, either type of intermittent claudication will siderail, at least to some degree, your plans for being active. It's just that each accomplishes this in a different way.

With vascular claudication, blood vessels narrow to the point where the amount of blood that flows through them is not enough to meet the demands of your lower extremity. Intermittent vascular claudication is usually due to peripheral vascular disease, or PVD.

Neurogenic refers to symptoms that arise when nerves that get impinged, which, as mentioned above, happens frequently in cases of lumbar spinal stenosis. In this case, claudication occurs when you stand up and your back is *relatively* more extended than it is when you're sitting down. It still may not be in an "extended" position, however. This, in turn, contributes to narrowing in either your spinal canal, your neural foramina, or both, often to the point where the sensitive nerve tissue that normally passes through these spaces unimpeded becomes compressed by the nearby bone or other structure. That's when symptoms such as neurogenic claudication may show up.

Spinal stenosis can be congenital, too, and in this case, your spinal canal and/or foramina are simply too small for the nerves that go through them. This may lead to irritation of nerves, again, causing symptoms.

Neurogenic Claudication Syndrome

Rather than a full-on disease or condition, neurogenic claudication is actually a syndrome. A syndrome is a collection of symptom consistently occur together.

Symptoms of neurogenic claudication are related to posture and may show up as pain in the low back and/or leg as muscle cramps. The combination of the presence of spinal stenosis with certain back postures such as arching puts pressure on lumbosacral nerve roots and/or the cauda equina. The cauda equina, a term that means horse's tail, refers to the loose bundle of nerves that extend below the main part of the spinal cord, and that, appropriately, resemble a tail. The cauda equina courses through the lumbosacral spine.

These symptoms of intermittent neurogenic claudication are often brought on by walking and/or moving toward that more arched position mentioned above, which is also called spinal extension.

They tend to be relieved by stooping, sitting, and/or bending forward at the waist.

Other symptoms of intermittent neurogenic claudication include pins and needles going down your leg, and/or leg weakness. Bowel or bladder problems may occur if the neurogenic claudication is severe. In this case, it's important to seek medical attention immediately.

Because lumbar spinal stenosis develops over time and is not a result of a one-time incident, it may take a while before symptoms are noticeable.

Treatment for Neurogenic Claudication

Treatment for neurogenic claudication usually begins conservatively. Your healthcare provider may prescribe pain medications and/or physical therapy. In physical therapy, you’ll likely be given exercises that emphasize forward flexion of the spine.

Other conservative treatments for lumbar spinal stenosis, and therefore, neurogenic claudication, include modifying your activity, wearing a back brace or belt, and/or having a spinal epidural injection to calm the pain. The North American Spine Society says that a series of spinal epidural injections of steroid medication may help to relieve pain from intermittent neurogenic claudication in the medium term; they define the medium term as 3 to 36 months.

In a commentary published in the Journal of the American Medical Association, Dr. Alexander Haig and his colleagues asserted that reliable, across-the-board standards for diagnosing and conservatively treating lumbar spinal stenosis are lacking. This could mean that some healthcare providers will use MRI, CT scans and/or EMG tests to diagnose your condition, while others may not. It could also mean that some healthcare providers may be more likely to "push" you into back surgery without first giving conservative treatments a chance. Do your research and talk to your healthcare provider about all your options before deciding what to do.

That said, if continued pain from intermittent neurogenic claudication greatly interferes with your lifestyle, it may well be a sign that you need back surgery. Usually, a laminectomy, which is also known as decompression surgery, is the procedure given for spinal stenosis.

A 2017 systematic review and meta-analysis published in the International Journal of Surgery that compared surgery to conservative care for lumbar spinal stenosis found that in the first six months after treatment, both approaches proved equally effective. After a year, though, surgery outcomes were better than those from conservative care. But surgery also was accompanied with more complications.

Based on the data, the researchers could not recommend one treatment type over the other.

5 Sources
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  1. Haig AJ, Park P, Henke PK. Reliability of the clinical examination in the diagnosis of neurogenic versus vascular claudicationSpine J. 2013;13(12):1826–1834. doi:10.1016/j.spinee.2013.06.021

  2. Munakomi S, Foris LA, Varacallo M. Spinal Stenosis And Neurogenic Claudication. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

  3. Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosisWorld J Orthop. 2014;5(2):134–145. doi:10.5312/wjo.v5.i2.134

  4. Haig AJ. Diagnosis and Management of Lumbar Spinal StenosisJama. 2010;303(1):71. doi:10.1001/jama.2009.1946

  5. Ma X-L, Zhao X-W, Ma J-X, Li F, Wang Y, Lu B. Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trialsInternational Journal of Surgery. 2017;44:329-338. doi:10.1016/j.ijsu.2017.07.032

Additional Reading

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.