page_title: Neurogenic claudication
section_title: Treatment
hierarchical_section_title: Neurogenic claudication / Treatment
caption_attribution_description: English: Epidural Steroid Injection. See a related animation of this medical topic.
context_page_description: Neurogenic claudication, also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord. Neurogenic means that the problem originates within the nervous system. Claudication, from the Latin word for to limp, refers to painful cramping or weakness in the legs. NC should therefore be distinguished from vascular claudication, which stems from a circulatory problem rather than a neural one.
  NC may involve one or both legs and usually presents as some combination of discomfort, pain, numbness, or weakness in the calves, buttocks, and/or thighs that is precipitated by walking and prolonged standing. The pain is classically relieved by a change in position or flexion of the waist. Therefore, patients with NC have less disability in climbing steps, pushing carts, and cycling.
  The term neurogenic claudication is sometimes used interchangeably with spinal stenosis. However, the former is a clinical term, while the latter more specifically describes the finding of spinal narrowing on imaging.
context_section_description: Decreased walking ability due to neurogenic claudication is the primary disabling feature of lumbar spinal stenosis (LSS). It is therefore the target of most treatments, which may be grouped broadly into nonsurgical and surgical options. Nonsurgical treatments include medications, physical therapy, and spinal injections. Medication options for neurogenic claudication have included non-steroidal anti-inflammatory drugs (NSAIDs), prostaglandins, gabapentin, and methylcobalamin. However, the quality of evidence supporting their use is not  high enough for specific recommendations. Physical therapy is commonly prescribed to patients, but the quality of evidence supporting its use for neurogenic claudication is also low. One quarter of all epidural injections are administered to treat symptoms of LSS. Preparations may contain lidocaine and/or steroids. They may be considered for short-term pain relief or to delay surgery, but their benefit is considered small. 
  Symptoms of LSS, including neurogenic claudication, are the most common reason patients 65 and older undergo spinal surgery. Surgery is generally reserved for patients whose symptoms do not improve with nonsurgical treatments. Spinal decompression is considered the mainstay of surgical treatment. Alternative surgical options include the use of interspinous process spacers, minimally invasive lumbar decompression (MILD) procedure, and placement of a spinal cord stimulator. The MILD procedure aims to relieve spinal cord compression by percutaneous removal of portions of the ligamentum flavum and lamina. The use of interspinous spacers is associated with increased costs and rates of reoperation, while evidence comparing effectiveness of the MILD procedure to spinal decompression is insufficient. While studies show that surgery improves walking ability, comparisons between the efficacy of surgical and nonsurgical treatment of LSS have yielded mixed results.
caption: Spinal injection into the epidural space
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