Neurogenic Claudication (NC)

Neurogenic claudication is a collection of symptoms resulting from lumbar spinal stenosis, or the narrowing of nerve passageways in the lower back. “Neurogenic” refers to having to do with the nerves, while “claudication” means “limping” in Latin, which describes the major symptoms of cramping and weakness in one or both legs when walking. The condition, generally seen in older people, gradually develops over time. It is characterized by the compression of the spinal cord or lumbosacral nerve roots, which pass through the fourth and fifth vertebrae (L4/L5) in the lower back (lumbar region) and the fifth vertebra and lumbosacral joint (L5/S1).

Causes

Age can be considered a major factor in the development of neurogenic claudication. Over time, the spongy discs of cartilage sandwiched between the vertebrae in your spine – the body’s natural shock absorbers – lose water and become less pliable. Gravity leads the adjacent vertebrae to compress the weakened disc, pushing the inner jelly-like nucleus pulposus outward into the walls of the annulus fibrosus. This can lead to a bulging or herniated disc, which may extend into and restrict spinal spaces where nerves are located. Once this degeneration has occurred, the chance of osteophytes (bone spurs) forming increases. The vertebrae can scrape against each other, amassing bony growths that can poke into and narrow the spinal canal, namely at the facet joints where the vertebrae are connected. Several cases have shown that enlarged, or hypertrophied, ligamentum flavum (“yellow ligament”) can also interfere with the spinal canal diameter. The elastic ligaments connect the vertebrae and allow for the extreme flexibility you have in your back and neck, but if a spinal ligament tissue becomes enlarged, it can pinch nerves.

Symptoms

Someone with neurogenic claudication will exhibit cramping, weakness, and tingling in the lower back and one or both buttocks and legs.  The symptoms are most evident during and after walking or standing because the spine extends when standing, naturally narrowing the spinal canal. Conversely, people find symptomatic relief after flexing the spine by sitting or leaning forward over an object like a shopping cart. The diameter of the spinal canal increases during flexion of the spine.

Treatments

Many people live with symptoms of neurogenic claudication by adapting to them: walking for a short period of time until symptoms flare, then sitting until the pain goes away. Treatment may begin conservatively with physical therapy, focusing on flexion exercises for the spine. Over-the-counter and prescribed pain medications may alleviate symptoms. Epidural steroid injections, which deliver medication directly to and around the area causing pain, may also be called for.

If conservative treatments for neurogenic claudication haven’t diminished your pain, contact the orthopedic specialists at Laser Spine Institute. Our state-of-the-art endoscopic techniques have helped tens of thousands of people rediscover their lives without back and neck pain.