What is Neurogenic Claudication?

Neurogenic claudication (NC) is pain in the legs that occurs as a consequence of lumbar spine disease. It arises from trapped nerve roots pressured due to a loss of space in the spinal canal, causing inflammation and neurological damage. The leg pain is sometimes accompanied by weakness and numbness elsewhere, such as in the buttocks or the lower back. Treatment options include physical therapy and medication, and sometimes neurosurgery to relieve pressure on the lumbar nerve roots.

Not a disease in its own right, neurogenic claudication is a major complication of spinal stenosis, the narrowing of the spinal canal that results in pressure on the nerve roots in the lumbar region. Unlike many neurological problems that come from compression of the spinal cord itself, neurogenic claudication usually results from damage to nerves as they exit the lumbar spine. Due to the amount of time that stenosis requires to develop, NC is a later-occurring symptom of the condition, which at first presents with lower back pain and discomfort.

Over time, often years, a spinal disc enlarges and shrinks the space inside the spinal canal. The ligament gradually thickens, further narrowing the area around the spine and pressuring nerve roots. The neurological problems that characterize neurogenic claudication, such as pain and weakness, arise from the trapped lumbar nerves and their subsequent inflammation and ischemia, or oxygen deprivation. Unlike the damage caused by a slipped or herniated disc, spinal stenosis can affect many roots at once and cause symptoms anywhere below the affected point in the vertebral column.

Neurogenic claudication most frequently occurs as bilateral and symmetrical pain and weakness in both legs, often calves or thighs. It can also present as pain radiating down the leg to the foot or as a unilateral set of symptoms in one limb. The discomfort varies with the extent of stenosis, which is usually most intense when the afflicted individual is walking or standing, since the spinal canal is narrower than when one is sitting or lying down. Patients are often middle-aged or older, and report leg pain more often than any other manifestation of lumbar spine stenosis.

Treatment of neurogenic claudication requires establishing the diagnosis by ruling out vascular claudication, which can have similar symptoms but results from a circulatory rather than a neurological problem. If NC is positively diagnosed, patients may choose between conservative, medical options and surgical treatment. The former include analgesic anti-inflammatory drugs, along with physical therapy and activities like tai chi and yoga. There is no single standard neurosurgical procedure to decompress nerves in patients with lumbar spinal stenosis. Common techniques to improve movement and relieve leg pain often remove ligaments to increase space within the spinal column and decompress the affected nerves.