Current diagnostic criteria for neurogenic claudication due to degenerative lumbar spinal stenosis do not include psychosocial factors (2,29).
Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists.
Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication.
What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis?
In contrast with neurogenic claudication
, vascular claudication clinical presentation includes a normal posture, diminished lower extremities pulse, stocking glove sensory loss, preserved leg strength, and trophic skin changes.
At tentative diagnosis of neurogenic claudication due to degenerative lumbar spinal stenosis was given and a treatment program of flexion-distraction/ side posture spinal mobilization/ manipulation, neural mobilization, flexion based home exercises including a progressive stationary cycling program was prescribed.
A tentative diagnosis of neurogenic claudication due to degenerative lumbar spinal stenosis with underlying congentially narrowed pedicles was given and a six week (twice per week) treatment program consisting of flexion-distraction and side posture spinal mobilization/ manipulation, neural mobilization of the femoral and sciatic nerves and, flexion based home exercises was started.
A diagnosis of neurogenic claudication is made clinically from a through history and physical examination and not solely by imaging evidence of spinal stenosis.
An understanding of the dynamic nature of neurogenic claudication and a comprehensive evaluation of other potential sources of symptoms and limited walking ability is paramount to appropriate diagnosis.
Factors observed by clinicians leading to changes included (1) criteria for some categories were largely similar, (2) the large number of categories created a lengthy exam, (3) the neurogenic claudication category required a checklist item(s) to help rule-out similarly presenting conditions, such as vascular claudication, (4) a single category entitled central pain better represented the chronic pain syndrome and non-organic pain categories, and (5) separating nociceptive and neuropathic pain diagnoses into subcategories is more aligned with clinical assessment.
We defined neuropathic pain as generated or perceived from peripheral or central nervous system tissues designated further into 4 subcategories: (1) compressive radiculopathy, (2) non-compressive radiculopathy, (3) neurogenic claudication, and (4) central pain.
Neurogenic claudication is thought to arise from compression of the cauda equina or nerve root(s) fostered by narrowing (stenosis) of the central spinal canal or neural foramina.