Neurogenic intermittent claudication, causes, symptoms, and treatment

Neurogenic intermittent claudication is also called Verbiest syndrome. It is a condition that is caused by a narrowing of the lumbar spinal canal. This condition mainly occurs in older (55 and 70 years) people. This article discusses the causes, symptoms and treatment of neurogenic intermittent claudication. The cause of neurogenic intermittent claudication is a narrowed spinal canal. Radiating pain in one or both legs is a major symptom of neurogenic intermittent claudication.

Cause of neurogenic intermittent claudication
The cause of neurogenic intermittent claudication is a narrowed spinal canal. This is generally caused by two things, namely a congenital narrow spinal canal or a degenerative disorder of the spinal canal. The degenerative disorder of the spinal canal which causes neurogenic intermittent claudication is usually osteoarthritis of the spinal canal.
Compression of the nerves (the cauda equina) and lumbar epidural veins causes the symptoms. In retroflexion, there is more pressure on the nerves, the venous pressure increases, and can cause ischemia of the cauda equina. In flexion the pressure in the spinal canal decreases and there is less pressure on the nerves, resulting in relief of the  complaints.

Clinical symptoms of neurogenic intermittent claudication
Below is an overview of the symptoms that someone with neurogenic intermittent claudication may have:
• Radiating pain in both legs (sometimes only in one leg) when walking and standing
• Weakness or paraesthesia (abnormal sensations such as a burning, stinging or tingling) in both legs (sometimes only in one leg)
• The above two symptoms disappear when bending, sitting or squatting
• When upright, the pain is present
• The pain may increase when the spine is stretched further back
• Going upstairs is easier than going downstairs
• Increasing fatigue in the legs, by which one is not able to walk on
• Loss of strength when walking
• When cycling, no pain is felt
• Morning stiffness (when there is osteoarthritis)
• Start pain (when there is osteoarthritis)
• The distance that can be walked before symptoms arise, is getting shorter
• By coughing, sneezing and straining the are symptoms provoked
• When stopped it takes minutes until the pain disappear (in vascular intermittent claudication is direct)

Physical examination for neurogenic intermittent claudication
When performing a physical examination of a patient with neurogenic intermittent claudication there are usually no abnormalities found. One can often find abnormalities in the physical examination when the symptoms are provoked. This can be done by letting the patient walk until the complaints occur.

When complaints are provoked the following symptoms can be found;
• Reduced or absent reflexes (usually the Achilles tendon reflex)
• Mild to moderate muscle weakness (this can usually be found in the muscles innervated by the roots L5 and S1)
• Radicular stimulation tests are usually negative.

Additional research in neurogenic intermittent claudication
With additional research (such as a CT or MRI) canal stenosis can be proven.

Course, prognosis and treatment of neurogenic intermittent claudication
Neurogenic intermittent claudication is usually not progressive. The complaints will not get worse.
However when the patients daily life is greatly impeded, surgery may be performed. A laminectomy will be performed, ie a whole or half vertebral arch is removed.

A. Hijdra, Koudstaal, PJ, Roos, RAC, Neurology (2003), Elsevier Health, Maarssen