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Managing Spinal Stenosis: Treatment Options

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Spine Care, Treatments

Spinal stenosis is the term used to describe a narrowing spine. Treatments vary because everybody’s case is different. Some individuals experience mild symptoms, while others experience severe symptoms. Can knowing treatment options help the patient and healthcare team customize and personalize a treatment plan to the individual’s condition?

Spinal Stenosis Treatments

Spaces within the spine can become narrower than they’re supposed to be, which can cause pressure on nerve roots and the spinal cord. Anywhere along the spine can be affected. The narrowing can cause pain, burning, and/or aching in the back and weakness in the legs and feet. Spinal stenosis has several primary treatments. When working through spinal stenosis treatments, a healthcare provider will assess symptoms and start treatment with first-line therapy, such as pain medication and/or physical therapy. These are often the first among individuals with the disease.

Medication

Chronic pain is one of the main symptoms. The first-line treatment often involves using pain-relieving medication/s. Commonly prescribed medications are nonsteroidal anti-inflammatories or NSAIDs. These medications reduce pain and inflammation. However, NSAIDs are not recommended for long-term use, and other medications may need to be used to relieve pain that includes: (Sudhir Diwan et al., 2019)

Tylenol – acetaminophen
Gabapentin
Pregabalin
Opioids for severe cases

Exercise

Exercise can reduce spinal stenosis symptoms by taking pressure off the nerves, which can reduce pain and improve mobility. (Andrée-Anne Marchand et al., 2021) Healthcare providers will recommend the most effective exercises for the individual. Examples include:

Aerobic exercises, such as walking
Seated lumbar flexion
Lumbar flexion in lying
Sustained lumbar extension
Hip and core strengthening
Standing lumbar flexion

Physical Therapy

Another primary spinal stenosis treatment is physical therapy, which is often used alongside pain medications. Typically, individuals undergo six to eight weeks of physical therapy, with sessions two to three times a week. Utilizing physical therapy has been shown to (Sudhir Diwan et al., 2019)

Reduce pain
Increase mobility
Reduce pain medications.
Reduce mental health symptoms like anger, depression, and mood changes.
For severe cases, physical therapy following surgery can reduce recovery times.

Back Braces

Back braces can help reduce movement and pressure on the spine. This is helpful because even small spinal movements can lead to nerve irritation, pain, and worsening symptoms. Over time, the bracing can lead to a positive increase in mobility. (Carlo Ammendolia et al., 2019)

Injections

Epidural steroid injections may be recommended to relieve severe symptoms. Steroids act as anti-inflammatories to reduce pain and swelling caused by inflammation and irritation of the spinal nerves. They are considered nonsurgical medical procedures. According to research, injections can effectively manage pain for two weeks and up to six months, and some research has found that after a spinal injection, relief can last 24 months. (Sudhir Diwan et al., 2019)

Thickened Ligaments Decompression Procedure

Some individuals may be recommended to undergo a decompression procedure. This procedure involves using a thin needle tool inserted into the back. The thickened ligament tissue is removed to reduce the pressure on the spine and nerves. Research has found that the procedure can reduce symptoms and the need for more invasive surgery. (Nagy Mekhail et al., 2021)

Alternative Treatments

In addition to first-line treatments, individuals may be referred to alternative therapies for symptom management, including:

Acupuncture

This involves the insertion of thin-tipped needles into various acupoints to relieve symptoms.
Some research has found that acupuncture may be more effective at reducing symptoms than physical therapy alone. Both options are viable and can improve mobility and pain. (Hiroyuki Oka et al., 2018)

Chiropractic

This therapy reduces pressure on nerves, maintains spinal alignment, and helps to improve mobility.

Massage

Massage helps to increase circulation, relax the muscles, and reduce pain and stiffness.

New Treatment Options

As spinal stenosis research continues, new therapies are emerging to help relieve and manage symptoms in individuals who don’t respond to traditional medicine or cannot partake in conventional therapies for various reasons. However, some evidence presented is promising; medical insurers may consider them experimental and not offer coverage until their safety has been proven. Some new treatments include:

Acupotomy

Acupotomy is a form of acupuncture that uses thin needles with a small, flat, scalpel-type tip to relieve tension in painful areas. Research on its effects is still limited, but preliminary data shows it could be an effective complementary treatment. (Ji Hoon Han et al., 2021)

Stem Cell Therapy

Stem cells are the cells from which all other cells originate. They act as the raw material for the body to create specialized cells with specific functions. (National Institutes of Health. 2016)

Individuals with spinal stenosis can develop soft tissue damage.
Stem cell therapy uses stem cells to help repair injured or diseased tissues.
Stem cell therapy can help repair or improve the damaged areas and provide symptom relief.
Clinical studies for spinal stenosis report that it could be a viable treatment option for some.
However, more research is needed to confirm whether the therapy is effective enough to be widely used. (Hideki Sudo et al., 2023)

Dynamic Stabilization Devices

LimiFlex is a medical device undergoing research and analysis for its ability to restore mobility and stability in the spine. It is implanted into the back through a surgical procedure. According to research, individuals with spinal stenosis who receive the LimiFlex often experience a higher reduction in pain and symptoms than with other forms of treatment. (T Jansen et al., 2015)

Lumbar Interspinous Distraction Decompression

Lumbar interspinous distraction decompression is another surgical procedure for spinal stenosis. The surgery is performed with an incision above the spine and places a device between two vertebrae to create space. This reduces movement and pressure on the nerves. Preliminary results show positive short-term relief from symptoms; long-term data is not yet available as it is a relatively new spinal stenosis treatment option. (UK National Health Service, 2022)

Surgical Procedures

There are several surgical procedures are available for spinal stenosis. Some include: (NYU Langone Health. 2024) Surgery for spinal stenosis is often reserved for individuals with severe symptoms, like numbness in the arms or legs. When these symptoms develop, it indicates a more notable compression of the spinal nerves and the need for a more invasive treatment. (NYU Langone Health. 2024)

Laminectomy

A laminectomy removes part or all of the lamina, the vertebral bone covering the spinal canal.
The procedure is designed to reduce pressure on nerves and the spinal cord.

Laminotomy and Foraminotomy

Both surgeries are used if an individual’s spinal stenosis negatively affects an opening in the vertebral foramen.
Ligaments, cartilage, or other tissues that constrict the nerves are removed.
Both reduce pressure on the nerves traveling through the foramen.

Laminoplasty

A laminoplasty relieves pressure on the spinal cord by removing parts of the spinal canal’s lamina.
This enlarges the spinal canal and relieves pressure on the nerves. (Columbia Neurosurgery, 2024)

Discectomy

This surgical procedure involves removing herniated or bulging discs that are placing pressure on the spinal cord and nerves.

Spinal fusion

Spinal fusion involves joining two vertebrae using metal pieces like rods and screws.
The vertebrae are more stable because the rods and screws act as a brace.

Which Treatment Is The Right One?

Because all treatment plans differ, determining the most effective is best suited for a healthcare provider. Each approach will be personalized to the individual. To decide what therapy is best, healthcare providers will assess: (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)

The severity of symptoms.
The current level of overall health.
The level of damage that’s occurring in the spine.
The level of disability and how mobility and quality of life are affected.

Injury Medical Chiropractic and Functional Medicine Clinic will work with an individual’s primary healthcare provider and/or specialists to help determine the best treatment options and concerns regarding medications or other forms of treatment.

Unlocking Wellness

References

Diwan, S., Sayed, D., Deer, T. R., Salomons, A., & Liang, K. (2019). An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach. Pain medicine (Malden, Mass.), 20(Suppl 2), S23–S31. https://doi.org/10.1093/pm/pnz133

Marchand, A. A., Houle, M., O’Shaughnessy, J., Châtillon, C. É., Cantin, V., & Descarreaux, M. (2021). Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Scientific reports, 11(1), 11080. https://doi.org/10.1038/s41598-021-90537-4

Ammendolia, C., Rampersaud, Y. R., Southerst, D., Ahmed, A., Schneider, M., Hawker, G., Bombardier, C., & Côté, P. (2019). Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial. The spine journal : official journal of the North American Spine Society, 19(3), 386–394. https://doi.org/10.1016/j.spinee.2018.07.012

Mekhail, N., Costandi, S., Nageeb, G., Ekladios, C., & Saied, O. (2021). The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain practice : the official journal of World Institute of Pain, 21(8), 826–835. https://doi.org/10.1111/papr.13020

Oka, H., Matsudaira, K., Takano, Y., Kasuya, D., Niiya, M., Tonosu, J., Fukushima, M., Oshima, Y., Fujii, T., Tanaka, S., & Inanami, H. (2018). A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study). BMC complementary and alternative medicine, 18(1), 19. https://doi.org/10.1186/s12906-018-2087-y

Han, J. H., Lee, H. J., Woo, S. H., Park, Y. K., Choi, G. Y., Heo, E. S., Kim, J. S., Lee, J. H., Park, C. A., Lee, W. D., Yang, C. S., Kim, A. R., & Han, C. H. (2021). Effectiveness and safety of acupotomy on lumbar spinal stenosis: A pragmatic randomized, controlled, pilot clinical trial: A study protocol. Medicine, 100(51), e28175. https://doi.org/10.1097/MD.0000000000028175

Sudo, H., Miyakoshi, T., Watanabe, Y., Ito, Y. M., Kahata, K., Tha, K. K., Yokota, N., Kato, H., Terada, T., Iwasaki, N., Arato, T., Sato, N., & Isoe, T. (2023). Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ open, 13(2), e065476. https://doi.org/10.1136/bmjopen-2022-065476

National Institutes of Health. (2016). Stem cell basics. U.S. Department of Health and Human Services. Retrieved from https://stemcells.nih.gov/info/basics/stc-basics

Jansen, T., Bornemann, R., Otten, L., Sander, K., Wirtz, D., & Pflugmacher, R. (2015). Vergleich dorsaler Dekompression nicht stabilisiert und dynamisch stabilisiert mit LimiFlex™ [A Comparison of Dorsal Decompression and Dorsal Decompression Combined with the Dynamic Stabilisation Device LimiFlex™]. Zeitschrift fur Orthopadie und Unfallchirurgie, 153(4), 415–422. https://doi.org/10.1055/s-0035-1545990

UK National Health Service. (2022). Lumbar decompression surgery: How It’s performed. https://www.nhs.uk/conditions/lumbar-decompression-surgery/what-happens/

NYU Langone Health. (2024). Surgery for spinal stenosis. https://nyulangone.org/conditions/spinal-stenosis/treatments/surgery-for-spinal-stenosis

Columbia Neurosurgery. (2024). Cervical laminoplasty procedure. https://www.neurosurgery.columbia.edu/patient-care/treatments/cervical-laminoplasty

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Spinal stenosis: Diagnosis, treatment and steps to take. Retrieved from https://www.niams.nih.gov/health-topics/spinal-stenosis/diagnosis-treatment-and-steps-to-take

The Benefits of Sleeping with a Pillow Between the Legs

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Sleep Hygiene

For individuals with back pain, can sleeping with a pillow between or under their knees help bring relief during sleep?

Sleep With A Pillow Between The Legs

Healthcare providers may recommend that individuals with back pain due to pregnancy or conditions like a herniated disc and sciatica sleep with a pillow between their legs. Sleeping with a pillow between the legs may help relieve back and hip pain, as the position helps maintain pelvis and spinal alignment. Proper spinal alignment can help relieve back stress and pain.

The Benefits

Some potential benefits of sleeping with a pillow between the knees.

Reduce Back and Hip Pain

When sleeping on the side, the spine, shoulders, and hips may twist to maintain the position because the center of gravity is elevated, causing instability. (Gustavo Desouzart et al., 2015) Placing a pillow between the knees may help maintain stability and reduce back and hip pain. (Gustavo Desouzart et al., 2015) The pillow neutralizes the position of the pelvis by slightly elevating the leg on top. This decreases the pressure on the lower back and hip joints, which may help reduce pain and allow for improved sleep.

Reduce Sciatica Symptoms

Sciatica nerve pain travels from the lower back down one leg due to a compressed spinal nerve root in the lower back. (American Academy of Orthopaedic Surgeons, 2021) Sleeping with a pillow between the knees may help reduce symptoms and sensations. A pillow between the legs can help prevent twisting the back, rotating the spine, or tilting the pelvis during sleep.

Reduce Herniated Disc Symptoms

A herniated disc can pressure the spinal nerves, leading to pain and numbness. (Penn Medicine. 2024) Sleeping on the side can worsen herniated disc pain; however, placing a pillow between the knees keeps the pelvis in neutral alignment and prevents spinal rotation. Sleeping on the back with a pillow under the knees can also help reduce pressure on the disc. (University of Central Florida. N.D.)

Improve Posture

Maintaining healthy posture while sitting or standing is important to neuromusculoskeletal health and injury prevention. Proper alignment during sleep can help improve posture (Doug Cary et al., 2021). According to one study, individuals spend more than half of their time sleeping in a side-lying posture. (Eivind Schjelderup Skarpsno et al., 2017) Sleeping on the side with the top leg frequently falls forward, bringing the pelvis into a forward tilt that places added pressure on the hips and spine connective tissues. This position disrupts the body’s natural alignment. (Doug Cary et al., 2021) Placing a pillow between the knees improves sleeping posture by lifting the top leg and prevents forward shifting. (University of Rochester Medical Center. 2024)

Pregnancy

Pregnancy pain in the back and pelvic girdle is due to: (Danielle Casagrande et al., 2015)

Increased weight leads to increased pressure on joints.
Significant change in the center of gravity.
Hormonal changes make connective tissues more lax.

Pregnant women with hip or back pain are often recommended to sleep with a pillow between their knees to relieve pain and discomfort. Doctors agree that lying on the left side is the best sleep position during the second and third trimesters. This position ensures optimal blood flow for the mother and baby and helps kidney function. (Standford Medicine, 2024) Placing a pillow between the knees can help reduce the pressure on the joints and also help maintain the left-side lying position. (O’Brien LM, Warland J. 2015) (Standford Medicine, 2024) Larger maternity pillows supporting the abdomen and lower back can provide more comfort.

Consult a healthcare provider about sleeping with a pillow between the knees to see if it is right for you.

What Causes Disc Herniation?

References

Desouzart, G., Matos, R., Melo, F., & Filgueiras, E. (2015). Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work (Reading, Mass.), 53(2), 235–240. https://doi.org/10.3233/WOR-152243

American Academy of Orthopaedic Surgeons. (2021). Sciatica. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/sciatica

Penn Medicine. (2024). Herniated disc disorders. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/herniated-disc-disorders

University of Central Florida. (N.D.). The best sleeping position for lower back pain (and the worst). UFC Health Services. https://ucfhealth.com/our-services/lifestyle-medicine/best-sleeping-position-for-lower-back-pain/

Cary, D., Jacques, A., & Briffa, K. (2021). Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study. PloS one, 16(11), e0260582. https://doi.org/10.1371/journal.pone.0260582

Skarpsno, E. S., Mork, P. J., Nilsen, T. I. L., & Holtermann, A. (2017). Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Nature and science of sleep, 9, 267–275. https://doi.org/10.2147/NSS.S145777

University of Rochester Medical Center. (2024). Good sleeping posture helps your back. Health Encyclopedia. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4460

Casagrande, D., Gugala, Z., Clark, S. M., & Lindsey, R. W. (2015). Low Back Pain and Pelvic Girdle Pain in Pregnancy. The Journal of the American Academy of Orthopaedic Surgeons, 23(9), 539–549. https://doi.org/10.5435/JAAOS-D-14-00248

Standford Medicine. (2024). Sleeping positions during pregnancy. Standford Medicine Children’s Health. https://www.stanfordchildrens.org/en/topic/default?id=sleeping-positions-during-pregnancy-85-P01238

O’Brien, L.M., Warland, J. (2015). Maternal sleep position: what do we know where do we go? BMC Pregnancy Childbirth, 15, Article A4 (2015). https://doi.org/doi:10.1186/1471-2393-15-S1-A4

The Role of Decompression Therapy in Restoring Spinal Disc Height

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Chronic Pain, Herniated Disc, Mobility & Flexibility, Spinal Decompression Treatments, Spine Care, Treatments, Viscerosomatic Reflex

Can individuals with spinal pain in their necks and back utilize decompression therapy to restore spinal disc height and find relief?

Introduction

Many people don’t realize that as the body gets older, so does the spine. The spine is part of the musculoskeletal system that provides structural support to the body by keeping it upright. The surrounding muscles, ligaments, and tissues surrounding the spine help with stability and mobility, while the spinal disc and joints provide shock absorption from the sheer vertical weight. When a person is on the move with their daily activities, the spine can allow the individual to be mobile without pain or discomfort. However, as time passes, the spine goes through degenerative changes that can cause pain and discomfort to the body, thus leaving the individual to deal with overlapping risk profiles that can affect their neck and back. To that point, many people seek out treatments to reduce the pain affecting their spine and restore the disc height in their bodies. Today’s article looks at how spinal pain affects a person’s neck and back and how treatments like spinal decompression can reduce spinal pain and restore disc height. We talk with certified medical providers who consolidate our patients’ information to assess how spinal pain can significantly impact a person’s well-being and quality of life in their bodies. We also inform and guide patients on how integrating spinal decompression can help reduce spinal pain and restore spinal disc height. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating non-surgical treatments into a health and wellness routine to relieve spinal pain and regain their quality of life. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

How Spinal Pain Affects A Person’s Neck & Back

Do you feel constant muscle aches and pains in your neck and back? Have you experienced stiffness and limited mobility when you are twisting and turning? Or do heavy objects cause muscle strain when moving from one location to another? Many individuals will be on the move and be in weird positions without feeling pain and discomfort when it comes to the spine. This is due to the surrounding muscles and tissues being stretched and the spinal discs taking on the vertical pressure on the spine. However, when environmental factors, traumatic injuries, or natural aging start to affect the spine, it can lead to the development of spinal pain. This is because the outer portion of the spinal disc is intact, and the inner portion of the disc is being affected. When abnormal stresses start to reduce the water intake within the disc, it can internally stimulate the pain receptors without nerve root symptoms inside the disc. (Zhang et al., 2009) This causes many individuals to deal with neck and back pain in their bodies and reduces their quality of life.

Spinal pain can lead to overlapping risk profiles that cause many individuals to deal with severe low back pain and neck pain, which then causes the surrounding muscles to become weak, tight, and overstretched. At the same time, the surrounding nerve roots are also affected as the nerve fibers surround the outer and inner parts of the spinal disc, which causes nociceptive pain properties to the neck and back region and leads to discogenic pain. (Coppes et al., 1997) When many individuals are dealing with muscle pain correlated with the spinal discs, it causes a pain-spasm-pain cycle that can affect their bodies due to not moving enough and causing painful muscular activities when trying to be mobile. (Roland, 1986) When a person has limited mobility cause they are experiencing spinal pain, their natural disc height slowly degenerates, causing more issues to their bodies and socioeconomic burdens. Fortunately, when many individuals are dealing with spinal pain, numerous treatments can reduce spinal pain and restore their disc height.

Movement Medicine- Video

How Spinal Decompression Reduces Spinal Pain

When people are seeking treatments for their spinal pain, many will seek surgical treatments to reduce their pain, but it will be a bit pricey. However, many individuals will opt for non-surgical treatments due to their affordability. Non-surgical treatments are cost-effective and customizable to a person’s pain and discomfort. From chiropractic care to acupuncture, depending on the severity of the person’s pain, many will find the relief they seek. One of the most innovative treatments for reducing spinal pain is spinal decompression. Spinal decompression allows the individual to be strapped into a traction table. This is because it gently pulls on the spine to realign the spinal disc by reducing the pressure on the spine to invoke the body’s natural healing process to relieve pain. (Ramos & Martin, 1994) Additionally, when many individuals are using spinal decompression, the gentle traction provides a motorized distraction to the spine that may induce physical changes to the spinal disc and help restore a person’s range of motion, flexibility, and mobility. (Amjad et al., 2022)

Spinal Decompression Restoring Spinal Disc Height

When a person is being strapped into the spinal decompression machine, the gentle traction helps the spinal disc return to the spine, allowing the fluids and nutrients to rehydrate the spine, increasing the spine’s disc height. This is because spinal decompression creates negative pressure on the spine, allowing the spinal disc to return to its original height and providing relief. Plus, the amazing thing that spinal decompression does is that it can be combined with physical therapy to help stretch and strengthen the surrounding muscles near the spine to provide more stability and flexibility. (Vanti et al., 2023) This allows the individual to be more mindful of their bodies and start incorporating small habit changes to reduce the pain from returning. When many people begin to think about their health and wellness by going to treatment, they will regain their quality of life and get back to their daily routine without the issues affecting their spine.

References

Amjad, F., Mohseni-Bandpei, M. A., Gilani, S. A., Ahmad, A., & Hanif, A. (2022). Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord, 23(1), 255. https://doi.org/10.1186/s12891-022-05196-x

Coppes, M. H., Marani, E., Thomeer, R. T., & Groen, G. J. (1997). Innervation of “painful” lumbar discs. Spine (Phila Pa 1976), 22(20), 2342-2349; discussion 2349-2350. https://doi.org/10.1097/00007632-199710150-00005

Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg, 81(3), 350-353. https://doi.org/10.3171/jns.1994.81.3.0350

Roland, M. O. (1986). A critical review of the evidence for a pain-spasm-pain cycle in spinal disorders. Clin Biomech (Bristol, Avon), 1(2), 102-109. https://doi.org/10.1016/0268-0033(86)90085-9

Vanti, C., Saccardo, K., Panizzolo, A., Turone, L., Guccione, A. A., & Pillastrini, P. (2023). The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis. Acta Orthop Traumatol Turc, 57(1), 3-16. https://doi.org/10.5152/j.aott.2023.21323

Zhang, Y. G., Guo, T. M., Guo, X., & Wu, S. X. (2009). Clinical diagnosis for discogenic low back pain. Int J Biol Sci, 5(7), 647-658. https://doi.org/10.7150/ijbs.5.647

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Relief from Neurogenic Claudication: Treatment Options

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Nerve Injury, Sciatica

Individuals experiencing shooting, aching pain in the lower extremities, and intermittent leg pain could be suffering from neurogenic claudication. Can knowing the symptoms help healthcare providers develop an effective treatment plan?

Neurogenic Claudication

Neurogenic claudication occurs when spinal nerves become compressed in the lumbar or lower spine, causing intermittent leg pain. Compressed nerves in the lumbar spine can cause leg pain and cramps. The pain usually worsens with specific movements or activities like sitting, standing, or bending backward. It is also known as pseudo-claudication when the space within the lumbar spine narrows. A condition known as lumbar spinal stenosis. However, neurogenic claudication is a syndrome or group of symptoms caused by a pinched spinal nerve, while spinal stenosis describes the narrowing of the spinal passages.

Symptoms

Neurogenic claudication symptoms can include:

Leg cramping.
Numbness, tingling, or burning sensations.
Leg fatigue and weakness.
A sensation of heaviness in the leg/s.
Sharp, shooting, or aching pain extending into the lower extremities, often in both legs.
There may also be pain in the lower back or buttocks.

Neurogenic claudication is different from other types of leg pain, as the pain alternates – ceasing and beginning randomly and worsens with specific movements or activities. Standing, walking, descending stairs, or flexing backward can trigger pain, while sitting, climbing stairs, or leaning forward tends to relieve pain. However, every case is different. Over time, neurogenic claudication can affect mobility as individuals try to avoid activities that cause pain, including exercise, lifting objects, and prolonged walking. In severe cases, neurogenic claudication can make sleeping difficult.

Neurogenic claudication and sciatica are not the same. Neurogenic claudication involves nerve compression in the central canal of the lumbar spine, causing pain in both legs. Sciatica involves compression of nerve roots exiting from the sides of the lumbar spine, causing pain in one leg. (Carlo Ammendolia, 2014)

Causes

With neurogenic claudication, compressed spinal nerves are the underlying cause of the leg pain. In many cases, lumber spinal stenosis – LSS is the cause of pinched nerve. There are two types of lumbar spinal stenosis.

Central stenosis is the main cause of neurogenic claudication. With this type, the central canal of the lumbar spine, which houses the spinal cord, narrows, causing pain in both legs.
Lumbar spinal stenosis can be acquired and develop later in life due to spine deterioration.
Congenital means the individual is born with the condition.
Both can lead to neurogenic claudication in different ways.
Foramen stenosis is another type of lumbar spinal stenosis that causes the narrowing of spaces on either side of the lumbar spine where nerve roots branch off the spinal cord. The associated pain is different in that it is either in the right or left leg.
The pain corresponds to the side of the spinal cord where the nerves are being pinched.

Acquired Lumbar Spinal Stenosis

Lumbar spinal stenosis is usually acquired due to the degeneration of the lumbar spine and tends to affect older adults. The causes of the narrowing can include:

Spinal trauma, such as from a vehicle collision, work, or sports injury.
Disc herniation.
Spinal osteoporosis – wear-and-tear arthritis.
Ankylosing spondylitis – a type of inflammatory arthritis that affects the spine.
Osteophytes – bone spurs.
Spinal tumors – non-cancerous and cancerous tumors.

Congenital Lumbar Spinal Stenosis

Congenital lumbar spinal stenosis means an individual is born with abnormalities of the spine that may not be apparent at birth. Because the space within the spinal canal is already narrow, the spinal cord is vulnerable to any changes as the individual ages. Even individuals with mild arthritis can experience symptoms of neurogenic claudication early on and develop symptoms in their 30s and 40s instead of their 60s and 70s.

Diagnosis

Diagnosis of neurogenic claudication is largely based on the individual’s medical history, physical examination, and imaging. The physical examination and review identify where the pain is presenting and when. The healthcare provider may ask:

Is there a history of lower back pain?
Is the pain in one leg or both?
Is the pain constant?
Does the pain come and go?
Does the pain get better or worse when standing or sitting?
Do movements or activities cause pain symptoms and sensations?
Are there any usual sensations while walking?

Treatment

Treatments can consist of physical therapy, spinal steroid injections, and pain meds. Surgery is a last resort when all other therapies are unable to provide effective relief.