Summary about Disease
Neurogenic claudication, also known as pseudoclaudication, is a syndrome characterized by pain, numbness, and/or weakness in the legs due to compression of the spinal nerves in the lower back. This compression is often caused by spinal stenosis (narrowing of the spinal canal). Unlike vascular claudication (caused by poor blood flow), neurogenic claudication is typically relieved by sitting or bending forward, which opens up the spinal canal and reduces pressure on the nerves.
Symptoms
Pain in the lower back, buttocks, thighs, or legs
Numbness or tingling in the legs or feet
Weakness in the legs or feet
Symptoms are often triggered by walking or standing for prolonged periods
Symptoms are typically relieved by sitting, bending forward, or lying down
"Shopping cart sign" - patient leans forward while walking to relieve pain
Causes
Spinal stenosis (narrowing of the spinal canal) is the most common cause.
Degenerative disc disease: breakdown of the spinal discs
Spondylolisthesis: a vertebra slips out of position
Herniated disc: a disc bulges and presses on the spinal nerves
Spinal tumors or cysts (rare)
Medicine Used
Pain relievers: Over-the-counter medications like acetaminophen or ibuprofen.
NSAIDs (Nonsteroidal anti-inflammatory drugs): Prescription-strength NSAIDs like naproxen or celecoxib.
Muscle relaxants: Cyclobenzaprine or baclofen may be prescribed to relieve muscle spasms.
Antidepressants: Tricyclic antidepressants (e.g., amitriptyline) or SNRIs (e.g., duloxetine) can help with nerve pain.
Anticonvulsants: Gabapentin or pregabalin can also help with nerve pain.
Corticosteroids: Oral corticosteroids may be prescribed for short-term relief of inflammation. Epidural steroid injections are a common treatment option that provides more targeted relief.
Opioids: May be used in severe cases but are typically avoided due to the risk of dependence.
Is Communicable
No, neurogenic claudication is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Maintain good posture.
Use proper lifting techniques.
Maintain a healthy weight.
Engage in regular exercise to strengthen back and abdominal muscles.
Avoid activities that worsen symptoms.
Use assistive devices, such as a walker or cane, if needed.
Consult with a physical therapist for exercises and strategies to manage symptoms.
How long does an outbreak last?
Neurogenic claudication does not have "outbreaks." It is a chronic condition, and the duration of symptoms can vary greatly. Without treatment, the symptoms can persist indefinitely. The length of time symptoms last depends on the underlying cause and severity of the nerve compression. Symptoms may fluctuate in intensity and may be episodic, meaning they come and go. With proper management and treatment, symptoms can be significantly reduced or controlled.
How is it diagnosed?
Medical history and physical exam: The doctor will ask about your symptoms and perform a physical exam to assess your strength, reflexes, and sensation.
Neurological exam: Tests nerve function.
Imaging tests:
X-rays: Can show bone abnormalities and spinal alignment.
MRI (Magnetic Resonance Imaging): Provides detailed images of the spinal cord, nerves, and soft tissues to identify stenosis, disc herniation, or other causes of nerve compression.
CT scan (Computed Tomography): Can provide detailed images of the bones of the spine.
Electromyography (EMG) and Nerve Conduction Studies (NCS): May be used to assess nerve function.
Vascular Studies: Ankle-Brachial Index (ABI) to rule out vascular claudication.
Timeline of Symptoms
The development and progression of symptoms can vary:
Gradual onset: Symptoms often develop gradually over weeks, months, or years.
Initial phase: Mild pain, numbness, or weakness may be intermittent.
Progression: Symptoms gradually worsen and become more frequent or severe.
Stable phase: Symptoms may plateau for a period.
Exacerbations: Periods of increased symptoms can occur.
Important Considerations
Neurogenic claudication can significantly impact quality of life by limiting mobility and activity.
It's crucial to differentiate neurogenic claudication from vascular claudication, as the treatment approaches differ.
Treatment options range from conservative measures (physical therapy, pain management) to surgical intervention, depending on the severity and underlying cause.
Early diagnosis and management can help prevent long-term complications, such as permanent nerve damage.
Patient education about self-management strategies is essential.