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Spinal Stenosis and Neurogenic Claudication

Porter, Richard W., MD, FRCS, FRCSE

Spine Update

Neurogenic claudication is diagnosed from a classical history and complementary spinal imaging. The abnormal signs may be few. It should be distinguished from intermittent claudication (peripheral vascular disease), referred pain from the back or root pain that is aggravated by walking, and psychological distress.

Pathologically, a developmentally small canal is usually affected by multiple levels of segmental degenerative change, with venous pooling in the cauda equina between two levels of low pressure stenosis. There is probably then a failure of arterial vasodilatation of the congested roots in response to exercise, with symptoms in the legs when walking.

Once established, symptoms tend neither to improve nor deteriorate. Conservative management is reasonable. Otherwise decompression at the most significant stenotic level is probably adequate to obtain a good surgical result.

From the Royal College of Surgeons, Edinburgh, Scotland.

Acknowledgment date: August 25, 1994.

First revision date: August 20, 1995.

Second revision date: January 2, 1996.

Acceptance date: May 15, 1996.

Device status category: 1.

Address reprint requests to: Richard W. Porter, MD; Director of Education and Training; Royal College of Surgeons; Nicolson Street; Edinburgh, EH8 90W; Scotland

© Lippincott-Raven Publishers.