About this post: Understanding
Spinal Claudication vs Vascular Claudication.
Claudication is described as a pain that occurs in the legs during increased activity.
The best-known example is Vascular claudication resulting from impaired blood flow into the legs aggravated by especially uphill walking, subsiding with rest.
Spinal claudication is to be distinguished from vascular claudication by noting that standing and walking in the upright position causes a similar kind of pain into the legs, which in turn is relieved when the patient bends over forward, like resting on the push bar of a shopping trolley.
Both entities should be distinguished from Peripheral neuritis, where the glove and stocking distribution of the burning sensation is not influenced by walking or posture and is virtually always present.
Claudication often remains undiagnosed or is diagnosed late because patients (and doctors) may consider the pain as a result of the wear and tear of ageing. As the elderly usually reduce their physical activities both vascular and spinal claudication may be perceived to be less severe.
Spinal (Neurogenic) Claudication
Spinal claudication is most often associated with the so-called degenerative spinal disease most frequently occurring in the lumbar spine.
Spinal canal stenosis is the narrowing of the spinal canal often in the central region, although often the sides of the spinal canal and therefore the outlet foramina are also narrowed. In both instances, pressure is exerted on the nervous tissue causing neurological symptoms.
This is also called neurogenic claudication.
Because of the degenerative nature of the process causing spinal canal stenosis, which is often accompanied by instability in the spinal segments during movement, there is an element of mechanical degenerative back pain may also be involved.
Back pain is described by virtually all patients with degenerative spinal stenosis. However, the emphasis will often be on the discomfort into the legs. Symptoms start gradually, vary in intensity with periods where the symptoms can be very debilitating, other times the patient may actually experience minimal discomfort.
The diagnosis of Neurogenic claudication is found in the classical description by the patient. The pain radiates into the buttocks as well as down the legs while standing upright or walking in the upright position. Bending over forward, or lying down with the spine curved forward and the legs curled up in the fetal position may relieve the pain, even completely.
The pain will increase in intensity while walking longer distances, on stopping, stooping and bending the back forward or sitting down the pain will almost immediately improve.
These patients would note that riding a bicycle, pushing a shopping cart in the mall, even mowing the lawn by bending over forward is possible and comfortable, however standing and walking, leisure shopping with their partner without a cart to stoop over is “pure hell”.
Using a rollator while walking, which allows bending forward while walking and pushing the rollator, also allows the opportunity to take a seat during the trip. This allows much more activities than without.
Vascular claudication has to be differentiated from the Neurogenic variant as pain into the legs by the impaired arterial blood supply to the legs which cause the complaint.
Vascular claudication is brought on by walking, mainly uphill. On standing, the pain gradually improves whereafter walking can resume, only to experience the same pain again on walking further. Patients may notice that lying down will actually increase the pain in the legs. Discomfort classically start at the feet and lower legs and slowly move up the legs, especially when walking uphill.
Particular risk factors in patients with vascular disease that should receive definitive attention are smoking, controlling high blood pressure, managing Diabetes and considering a healthy diet to control raised cholesterol levels.
Claudication Exercise Testing can be used to determine the level of claudication and repeat tests at specific intervals would indicate if deterioration is present.
Note the distance walked on the same road with a slight incline at a certain speed before the pain starts. This will give an indication of symptom progression and indicate to your doctor if there is a need to intervene.
Vascular claudication symptoms include:
- Pain that comes and goes depending on the activities of the patient.
- The pain could be present in the whole leg of the patient from buttock to foot.
- The feet especially and the distal extremities can feel cold to the touch. Often a pulse is hard or even impossible to find.
- Because of reduced blood flow, skin discolouration (a blue tinge) may be seen.
- Skin breakdown and even sores (ulceration) may occur.
- In the advanced state of the disease, pain may occur while resting.
Your doctor can run some tests to determine diminished blood flow:
- Checking your pulse with an oximeter.
- ABI Test (Ankle Brachial Index test) measuring and comparing the blood flow in your extremities.
- Doppler ultrasound, which is blood flow monitoring.
- MRI (Magnetic resonance imaging) as functional imaging done by a specially trained Radiologist.
Also read “Peripheral Neuritis“