Neurogenic intermittent claudication in patients with degenerative lumbar stenosis

Nikitin, A V; Камчатнов, П Р

doi:10.17116/jnevro20211210517

Z. nevrol. psikhiatr. im. S.S. Korsakova

2021

DOI: 10.17116/jnevro20211210517

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Neurogenic intermittent claudication in patients with degenerative lumbar stenosis

A V Nikitin¹,

П Р Камчатнов²

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Cited by 2 publications

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Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Parfenov,

Davydov,

Churyukanov

et al. 2024

RJTAO

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Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

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Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Parfenov,

Davydov,

Churyukanov

et al. 2024

RJTAO

View full text Add to dashboard Cite

show abstract

Neurological disorders imitating spinal stenosis in elderly patients. Series of clinical observations

Seliverstova,

Kordonskiy,

Druzhinina

et al. 2023

Nejrohirurgiâ (Mosk.)

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Spinal stenosis is a pathological narrowing of the central spinal canal, lateral pocket, or intervertebral foramen due to age‑related changes, including pathology of the discs, facet joints, ligament hypertrophy, osteophyte formation and destruction of the arches. Clinically, the disease can manifest itself with pain, as well as numbness, or weakness in the arms or legs. The complexity of differential diagnosis is due to the lack of correlation between the degree of stenosis according to neuroimaging data and the severity of clinical manifestations. Spinal stenosis among 21 % of people may have an asymptomatic course.Spinal stenosis has to be differentiated from atherosclerosis of the vessels of the lower extremities, rheumatoid arthritis, piriformis syndrome, sacroiliitis, spondylitis/spondylodiscitis, amyotrophic lateral sclerosis, Guillain–Barré syndrome and other polyneuropathies. Isolated weakness should be of a particular concern in the clinical picture. Muscle hypotrophy, brisk tendon reflexes, the presence of pyramidal signs, muscle fasciculations, as well as patients’ complaints of simultaneous weakness in both the upper and lower extremities accompany them.We present and discuss three clinical cases of patients with a presumptive diagnosis of spinal stenosis. Two of them were held surgical treatment, which did not produce the expected result. Subsequently, it was found that the cause of progressive muscle weakness in the limbs was amyotrophic lateral sclerosis in two patients and the third one had Guillain–Barré syndrome, a form of acute demyelinating polyneuropathy.

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Neurogenic intermittent claudication in patients with degenerative lumbar stenosis

Cited by 2 publications

References 18 publications

Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Neurological disorders imitating spinal stenosis in elderly patients. Series of clinical observations

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