OrthoNeuroSpine & Pain Institute
Neurogenic claudication is one of the most typical side effects of spinal stenosis, a condition in which spinal nerves become compressed by narrowed pathways in the spinal column. "Neurogenic" indicates that the problem deals with a nerve, and "claudication" is derived from the Latin word for "limp," because this condition is defined by weakness, cramping, discomfort, and pain in the legs that can make it difficult to walk.
As mentioned above, neurogenic claudication often results from spinal stenosis, typically in the lumbar (lower) region of the spine. This degenerative spine condition develops over time as part of the natural aging process. Over the years, the openings through which spinal nerves pass can become constricted and place pressure on the nerves. This nerve compression is what can cause neurogenic claudication.
The symptoms of neurogenic claudication are most often felt in the calves, but can present in the hips, buttocks, thighs, or feet. The symptoms can include:
- Tired feeling
Typically, conservative, nonsurgical methods of treatment are effective in managing the symptoms of spinal stenosis, including neurogenic claudication. Conservative treatments can include physical therapy, hot/cold therapy, pain medication, exercise, and others. However, some individuals cannot find relief through these methods and instead turn to surgery. Endoscopic procedures are minimally invasive alternatives to open back surgery and can help you find relief from back and neck pain.
Neurogenic claudication is discomfort in the lower back or legs caused by nerve compression in the lumbosacral region of the spine. This is distinct from vascular claudication, which is caused by a circulatory problem within the lower back, buttocks, or legs. Neurogenic means that the symptoms are related to a nerve, and claudication - which is Latin for "limp" - refers to cramping or weakness in the legs. Symptoms can be experienced bilaterally (both legs) or unilaterally (one leg), often are exacerbated by extended periods of walking or standing, and generally worsen over time.
How Neurogenic Claudication Develops:
Nerve compression within the lumbar (lower back) or sacral (pelvis) regions of the spine is commonly caused by spinal stenosis, which in turn can arise from one or more degenerative spine conditions associated with the aging process or injury. Diminished blood supply (ischemia) of the horse-tail-like bundle of nerves at the bottom of the spinal cord (the cauda equina) also can lead to neurogenic claudication. Degenerative spine conditions typically associated with lumbosacral spinal stenosis include:
- Hypertrophic ligamentum flavum - thickening of one of the major ligaments responsible for connecting vertebrae.
- Inflamed facet joints - osteoarthritis within the joints connecting the vertebrae.
- Herniated disc - extrusion of the inner material of an intervertebral disc through a fissure in the disc's outer wall.
- Bulging disc - protrusion of a portion of the outer wall of an intervertebral disc.
- Osteophytes - bone spurs associated with osteoarthritis.
- Spondylolisthesis - slippage of one vertebra over another.
What Causes Neurogenic Claudication?
Neurogenic claudication is leg or lower back discomfort produced by nerve compression in the lumbosacral region of the spine. This can be caused by traumatic injury, but is more frequently a result of spinal degeneration associated with the aging process. As we age, the components of the spinal anatomy - vertebrae, intervertebral discs, spinal joints, ligaments, and more - begin to break down after years of wear and tear. This age-related degeneration reduces the space available for nerve roots and the spinal cord itself, which can lead to nerve compression that causes symptoms such as pain, tingling, numbness, or muscle weakness.
Conditions Leading to Neurogenic Claudication:
Patients with neurogenic claudication often experience trouble after extended periods of walking or standing. Symptoms typically are mild at first, and become more severe as the underlying degenerative condition worsens. These degenerative conditions include:
- Disc degeneration - intervertebral discs begin to lose water content and elasticity over time. This reduces the height of the disc, diminishing the space available for nerve roots and potentially bringing bony elements of the spinal anatomy into contact with one another.
- Arthritis of the spine - the facet joints, the hinges along the spine where the vertebrae meet and articulate, tend to wear down over time. This joint degeneration can reduce space available for adjacent nerve roots or cause vertebrae to rub together.
- Injury - trauma caused by a fall or a collision can disrupt the spinal anatomy, either directly producing symptoms or exacerbating existing degenerative conditions.
What to do About Neurogenic Claudication
If you begin to experience unexplained pain or tingling in the lower back, buttocks, or legs, see your doctor for a diagnosis. If it turns out to be neurogenic claudication, there is a good chance the symptoms can be managed using conservative treatments such as exercise and/or pain medication.
Many patients experiencing the early stages of neurogenic claudication find short-term relief through stooping, sitting, or bending forward at the waist. In more severe cases, a doctor may recommend a course of conservative treatment that includes an organized exercise program or pain medication. If chronic pain, tingling or weakness persist after several months of conservative treatment, nerve decompression surgery may be recommended.
What are the Symptoms of Neurogenic Claudication?
Neurogenic claudication, also known as spinal claudication, is a result of nerve compression in the lower portion of the spine. The associated discomfort within the lower back, buttocks, thighs, and calves can occur on both sides (bilaterally) or on one side only (unilaterally). It can be distinguished from a similar condition, vascular claudication, in that nerve-related discomfort typically is consistent, while muscle aches associated with vascular disorders usually are intermittent.
What Neurogenic Claudication Feels Like
Spinal stenosis, or a narrowing of the spinal canal associated with a degenerative spine condition or injury, can lead to neurogenic claudication if adjacent nerves are irritated. Degenerative conditions commonly arise at the L4-L5 level (between the fourth and fifth lumbar vertebrae) or the L5-S1 level (between the fifth lumbar and first sacral vertebrae). Nerve roots at that level innervate the lower body, and an interruption of neural function in and around the lower spine can lead to the following symptoms:
- Mild pain or cramping in the lower back and/or buttocks that becomes increasingly worse.
- Tingling, or a pins and needles feeling, that travels down the lower back, through the buttocks, and into the thigh.
- Weakness that affects muscle groups innervated by the affected nerve or nerves.
- Bowel or bladder problems, if nerve compression affects the cauda equina, which is a bundle of nerves that extends off the bottom of the spinal cord; this can be a severe, even life-threatening condition, and medical treatment should be sought immediately.
How to Treat Neurogenic Claudication
More often than not, people who suffer from neurogenic claudication can experience immediate - if temporary - relief by sitting down or bending forward at the waist. The symptoms of discomfort in the lower back, buttocks, thighs, or calves typically diminish somewhat when the spine is stretched. This is because the compressed nerve structures that are causing the symptoms are given more space, thereby removing the source of discomfort. However, merely sitting down or bending forward will not permanently decompress an affected nerve root, particularly if the compression is caused by a degenerative spine condition associated with the aging process, such as a herniated disc or arthritis of the spine.
Conservative Treatments for Neurogenic Claudication
Neurogenic claudication symptoms typically begin as mild pain in the lower back or tingling in the buttocks, thighs, or calves. These symptoms can be experienced on both sides of the body (bilaterally) or only on one side (unilaterally). Symptoms tend to worsen over time, especially if an associated degenerative spine condition is left untreated. If the discomfort associated with neurogenic claudication persists, a doctor may recommend a course of conservative treatment. These methods include:
- Exercise geared toward flexing the spine forward, thereby creating more space for the affected nerve structures.
- Over-the-counter or prescription medication that reduces pain or inflammation.
- Epidural steroidal injections that temporarily reduce pain in the area affected by nerve compression.
- Behavior modification that encourages better posture habits.
- A brace or belt to support the lower back and inhibit activities that produce symptoms.