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Neurogenic Intermittent Claudication

Types and causes of neurogenic intermittent claudication

Neurogenic intermittent claudication is a pathognomonic symptom that suggests the presence of spinal stenosis before additional examination methods. It is characterized by pain when walking, which regresses when sitting down or bending the body forward. After that, a person can again walk a certain distance until painful sensations appear. In a sitting position, the patient can perform any work (exercise bike, driving a car) without pain. The intensity of neurogenic intermittent claudication is estimated in the distance (meters) that a person can walk before the onset of pain.

 

To stop neurogenic lameness, a person usually needs not only to stop walking but at the same time take a specific posture: with a slight bending of the legs in the hip and knee joints and bending the body forward. In this position, the lumbar spine is straightened, the distance between the posterior structures of the vertebra, the root increases, when the pressure stops, the spring expands, the pressure disappears, the thread is free, and it falls out. Neurogenic claudication often occurs in men over 40 years old, in women over 50 years old. But it may be earlier, depending on the reasons that caused the compression of the nervous tissue. Usually, the development of the disease is imprinted by the patient’s lifestyle: work, nutrition, excess weight, injuries, etc.

 

According to different researchers, the motor variant of intermittent neurogenic claudication occurs in 20% – 40% of cases. Usually, movement disorders in the legs are combined with reflex pain syndromes: soreness along the back, front, lateral surfaces of the thighs, lower legs, numbness of the same areas with spread to the foot.

Types and Causes of Neurogenic Intermittent Claudication

Types

The types of intermittent neurogenic claudication are divided into neurogenic and vascular.

  1. Neurogenic (due to compression, circulatory failure occurs, and if compression occurs chronically, atrophy of the nervous tissue occurs)
  2. Vascular (the most common cause of obliterating endarteritis and atherosclerosis)

But there are other, more rare causes from different branches of medicine that need excluding if the symptoms do not correspond to the two above: genetic diseases (dysmetabolic), traumatological (damage to the bursa, piriformis hypertrophy, etc.), neurological, psychogenic, etc.

 

Neurogenic intermittent claudication can be both unilateral (most often with damage to one root, for example, lateral hernia) and bilateral (due to stenosis of the spinal canal, central hernia). Or the onset of the disease is unilateral, followed by spread to the other side with or without the addition of pain, numbness, other unpleasant sensations, and dysfunctions of the pelvic organs.

 

Prerequisites

  • spinal stenosis (congenital / acquired, fixed / dynamic, monosegmental / polysegmental);
  • displacement of the vertebrae relative to each other (between them and the compression of the roots occurs);
  • the presence of bone growths;
  • overgrowth of joints;
  • consolidation of ligaments;
  • deposits in the bundles of calcium salts;
  • intervertebral hernia;
  • an increase in the size of the yellow ligament;
  • varicose veins of the spine.

 

Causes

Factors of neurogenic intermittent claudication are:

1. Initial factors are:

  • based on the periodic arising cessation of blood flow or its significant weakening to the spinal cord or its lumbosacral roots due to increased needs for movements with a simultaneously impaired vascular supply of the roots (with age, the lumen of the arteries becomes smaller, their elasticity and strength decrease) as a result of their compression surrounding tissues;
  • spasm of the arteries;
  • stagnation of blood in the venous system of the spine;
  • the pressure increase of the cerebrospinal fluid (from the side of the spinal cord and its roots) in the vertebral or radicular canal.

2. Producing factors are: 

  • not always, especially at the onset of the disease, the patient experiences pain and weakness in the lower extremities; 
  • most often, they are caused by a specific position of the body, for example, when moving to an upright position with the extension of the trunk while walking and standing;
  • reverse movement achieves pain relief: flexion of the spine – straightening the lordosis, tilting – to the healthy side, and stopping – to rest.

Diagnostics and Treatment of Neurogenic Claudication

Diagnostics

The syndrome of intermittent neurogenic claudication is presented clinically. With the help of instrumental examination methods, the cause is established, the location of the lesion and its compliance with the clinical picture is determined, and indications for conservative or surgical treatment methods are established.

 

Instrumental methods, the use of which is mandatory in the diagnosis of neurogenic intermittent claudication are:

  • X-ray of the lumbar spine in two projections and functional positions;
  • computed tomography of the level of stenosis;
  • myelography of the lumbar spine;
  • magnetic resonance imaging of the lumbar spine.

 

Additional research methods are:

  • selective angiography;
  • venography;
  • ENMG;
  • bicycle test (a patient with neurogenic claudication can engage in much longer than with vascular pathology).

Conservative Treatment

1. Conservative treatment includes:

  • taking non-steroidal anti-inflammatory drugs during an exacerbation;
  • drugs that relieve swelling and tonic vessels;
  • implanted nerve stimulators;
  • physiotherapy treatment;
  • physiotherapy exercises;
  • vertiflex procedure, if necessary.

The patient’s stopping of heavy physical activity is important, taking medications according to the doctor’s prescription.

 

Usually, conservative treatment is carried out in patients with mild to moderate intermittent neurogenic claudication syndrome for 1-3 months. With the ineffectiveness of conservative treatment, gross changes according to CT and MRI, and with the consent of the patient, surgical treatment is carried out.

 

2. Surgical treatment. Preparation for surgical treatment is performed according to the protocols.

 

The operation is performed under endotracheal anesthesia. The planned operation determines the position of the patient on the operating table. The type of operation is determined for each patient individually, depending on the cause of the pathology.

  • The primary purpose of the operation is decompression of neural structures (mechanically removing the structure compressing the nerve tissue), which is well defined by MRI examination.
  • The second stage is the stabilization of the spine with a metal structure.
  • When the hernia is completely removed, a metal or polymer cage is placed.

Hopefully, all this information was useful for you. Take care of yourself.

 

FAQs

  • How are nerve stimulators with neurogenic intermittent claudication implanted?

The implant consists of a central abutment with two wing-shaped branches. When it is precisely inserted between the two vertebrae, the physician will open these wings. In each wing, a recess holds the spinous processes of the vertebrae above and below the device. Once the implant is in place, it gently separates the two bones, which widens the spinal canal and relieves pressure on the nerves. The nerves are no longer pinched and the symptoms of lumbar spinal stenosis are reduced.

  • Can spinal stenosis be treated without surgery?

In the initial stages of the degenerative cascade, the symptoms of spinal stenosis may not bother at all. However, if the situation worsens, then it is no longer possible to cure the disease without surgery. Removal of stenosis is possible only by surgery.

  • What is the Vertiflex procedure?

The procedure involves the use of an implant, which is currently the only FDA-approved interspinous spacer on the market. This is an evidence-based procedure and is one of the most advanced life-enhancing procedures for those suffering from lumbar spinal stenosis. For 5 years, this method has helped patients get rid of leg pain in 75% of cases.

  • Do you need a Vertiflex procedure?

To understand this, ask yourself these questions:

  1. Are you experiencing cramps, numbness, pain, or tingling in your legs, calves, or seat?
  2. Is it aching, dull pain spreading from back to legs?
  3. Do you feel better when you are sitting, bending forward, lying on your back, or sitting with your legs up?

If your answer is “yes”, you need this procedure.

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Lone Star Neurology
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Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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