Neurogenic claudication

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Neurogenic claudication (NC), also known as pseudoclaudication, is a common symptom of lumbar spinal stenosis (LSS),[1][2] causing impingement or inflammation of the nerves emanating from the spinal cord. Neurogenic means that the problem originates with a problem at a nerve, and claudication, from the Latin for limp, because the patient feels a painful cramping or weakness in the legs. NC should therefore be distinguished from vascular claudication, which is when the claudication stems from a circulatory problem, not a neural problem.

Neurogenic claudication may present in one or both legs and usually presents as some combination of discomfort, pain, numbness and weakness in the calves, buttocks, and/or thighs. In some patients, it is precipitated by walking and prolonged standing. The pain is classically relieved by a change in position or flexion of the waist.[3] Although a flexed position may also potentially relieve symptoms, resting typically offers the greatest relief of pain.

Therefore, patients with neurogenic intermittent claudication have less disability in climbing steps, pushing carts and cycling.[3][4] This is because those movements flex the lumbar spine, and the vertebral foramen widens.

The pathophysiology is thought to be ischemia of the lumbosacral nerve roots secondary to compression from surrounding structures, hypertrophied facets, ligamentum flavum, bone spurs, scar tissue, and bulging or herniated discs.

In addition to vascular claudication, pseudo-trochanteric bursitis should be considered in differential diagnosis.

References[edit]

  1. ^ Comer CM, Redmond AC, Bird HA, Conaghan PG (2009). "Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists". BMC Musculoskelet Disord. 10: 121. doi:10.1186/1471-2474-10-121. PMC 2762954Freely accessible. PMID 19796387. 
  2. ^ Harrast MA (March 2008). "Epidural steroid injections for lumbar spinal stenosis". Curr Rev Musculoskelet Med. 1 (1): 32–8. doi:10.1007/s12178-007-9003-2. PMC 2684150Freely accessible. PMID 19468896. 
  3. ^ a b Genevay S, Atlas SJ (April 2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052Freely accessible. PMID 20227646. 
  4. ^ Djurasovic M, Glassman SD, Carreon LY, Dimar JR (April 2010). "Contemporary management of symptomatic lumbar spinal stenosis". Orthop. Clin. North Am. 41 (2): 183–91. doi:10.1016/j.ocl.2009.12.003. PMID 20399357.