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Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website
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Neurogenic Claudication and Lumbar Spinal Stenosis
- Do you get low back, buttocks, thighs, legs/calves aches, pains, and cramping when you stand and walk?
- Do you notice these symptoms worsen with the further distance you walk?
- Do you notice that these symptoms improve or nearly go away when you sit down?
- Are you walking shorter and shorter distances before getting these symptoms and needing to stop and sit?
- Do you notice that if you lean on a shopping cart you can walk further distances?
- Are you able to sit and ride a stationary bicycle for a longer time period than you can walk upright?
You could be having Neurogenic Claudication from Lumbar Spinal Stenosis!
Neurogenic claudication is the medical term for a particular set of symptoms that occur from lumbar spinal stenosis. Neurogenic means originating from nerves. Claudication is the Latin term for "limping." Lumbar is the lower portion of your spine in the low back region. Stenosis means narrowing and thus spinal stenosis means narrowing of the canal where your nerves are in your spine.
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Lumbar spine anatomy:
The lumbar spine is the low back region of the spine and is made up of your lumbar 1 (L1) - lumbar 5 (L5) bones (vertebrae), discs, and joints. The group of nerves in the lumbar spine canal region is called the cauda equina literally meaning "horse tail" which is what these many nerves together resemble. The spinal disc is a structure between each of the spinal bones that is made up of an outside fibrous structure called the annulus fibrosus that is somewhat more firm. The annulus contains an inside structure called the nucleus pulposus that is more soft and jelly-like. Lumbar spinal nerves travel inside a canal or tunnel in the back of your spine formed by stacked ring-like regions of your bones. There are other structures in the canal including a ligament called the ligamentum flavum and joint capsules. The nerves exit from the spine canal between two adjacent vertebrae at a region called the neuroforamen. The neuroforamen is a region formed by an upper arch and a lower valley. These nerves go through this area then branch out to various regions of the buttocks, thighs, legs/calves, and feet. These nerves carry signals from your brain to your muscles that control your movement and strength. These nerves also carry sensation/sensory signals from your skin, muscles, joints back to your spinal cord and then to your brain.
What causes spinal stenosis? Anything that causes the spinal canal to become narrowed and smaller causes spinal stenosis. Typically: - Disc herniation - If the inside disc material exits or breaks through the outside structure this is a disc herniation and this material can compress and "pinch" the nerves in that area.
- Lumbar arthritis and degeneration - Arthritis and degeneration is the wear and tear of our joints, discs, bones and body parts that occurs with time and with use. As a result, the bones can form spurs at different parts of the spine. The ligaments in the canal can also thicken and the joint capsules can also thicken with age. The bone spurs and thickened structures will occupy more of the spinal canal space and cause compression of the nerves in that area.
- Lumbar degenerative disc disease - Also a form of arthritis and degeneration is the wear and tear of your discs. Over time the annulus fibrosus may weaken and begin to bulge out and compress your nerves or spinal cord. This condition can lead to compression of the nerves in the spinal canal.
- Lumbar spondylolisthesis - The spinal canal is a tunnel formed by stacked rings at the back of each of your vertebrae. Spondylolisthesis is one bone slipping over another bone. Thus, if you slide two rings side by side, the area between the two rings can become narrowed which is stenosis.
Lumbar spinal stenosis symptoms:
Patients with lumbar spinal stenosis have compression of the nerves (cauda equina) running through the lumbar portion of your spine. This could lead to symptoms of neurogenic claudication which are typically aches, pains, cramping, fatigue of your low back, buttocks, back of your thighs, legs/calves, and feet. There may be associated weakness as well as numbness and tingling. These symptoms tend to worsen with standing upright or extending your back as well as walking in this upright position. Symptoms may be lessened or alleviated by walking in a flexed forward position such as with leaning on a shopping cart or with flexing the back by sitting down.
Treatments:
Spinal stenosis and symptoms of neurogenic claudication can be initially treated with non-surgical methods. However, these non-surgical methods do not reverse or remove the narrowing of the spinal canal and the compression of these neurologic structures. Furthermore, prolonged compression of neurologic structures could lead to permanent changes or damage to the nerves that will not improve even with surgery. Surgery is typically the last resort and is considered if you have failed non-operative measures or if you have progressive worsening neurologic function. Additionally, surgery could be pursued if you have a correlation among your history, symptoms, motor/sensory regions for pain and dysfunction, and diagnostic studies. There are multiple treatment options both nonsurgical and surgical. However, the appropriate options will depend on your unique condition and problems and after a spine specialist performs your evaluation and reviews your studies.
Nonsurgical treatment
- Medications (NSAIDs, Narcotic pain medications, Neurologic modulating medications)
- Physical Therapy
- Interventions (Spinal injections)
- Symptomatic treatment modalities (Ice, heat, massage)
- Activity modification. Ambulation assistance devices.
Surgical treatment
- Lumbar laminectomy, decompression, possible discectomy
- Fusion, spinal hardware instrumentation if there is significant spondylolisthesis/spinal instability
If you have questions or wish to schedule an evaluation by one of Cascade Orthopaedics' specialists, please call us at (253) 833-7750.
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice.
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