Neurogenic claudication

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Neurogenic claudication (NC, hereafter) is a common "presentation," or one symptom of, spinal stenosis, or inflamation of the nerves eminating from the spinal cord. Neurogenic means that the problem is originates with a problem at a nerve, and claudication, from the latin for limp, means that the patients feels a painful cramping and/or weakness. NC should therefore be distinguished from vascular claudication, which is when the caudication stems from a circulatory prorblem, not a nueral problem. NC can be bilateral or unilateral lateral calf, buttock, or thigh discomfort or pain and/or weakness. 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 (anthropoid position) and not simply relieved by rest, as in vascular claudication. Therefore patients with neurogenic intermittent claudication have less disability in climbing steps, pushing carts and cycling. In some patients with severe compression of the nerve roots, the NC is not intermittent but painfully persistent. 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 buldging or herniated discs. In addition to vascular claudication, trochanteric bursitis should be considered in the differential.