Pathophysiology
Neurogenic claudication is caused by lumbar stenosis. Vascular claudication is caused by narrowing of arteries which results in decreased blood flow to the legs.
Symptoms
Pain secondary to neurogenic claudication gets better when bending forward because this position widens the spinal canal (leaning on shopping cart/cane, walking up hill, biking). This position does not improve the symptoms of vascular claudication.
Physical Exam
Neurogenic claudication - neuro exam is often normal but can revel single or multiple lumbosacral radiculopathies. Cauda equina and myelopathy can be rare but serious complications. Vascular claudication - decreased peripheral pulses.
Treatment
Neurogenic claudication - unless symtoms severe, initial treatment is conservative with physical therapy, pain medications, and epidural injections. Spinal surgery can be considered if symtoms do not improve with conservative approach. Vascular claudication - physical therapy, antiplatelet medications and surgery depending on severity.
Sources
Markman, J MD and Gaud, K. BS "Lumbar Spinal stenosis in Older Adults: Curent Understanding and Future Directions." Clinics in Geriatric Medicine. 2008.
Levin, K. MD. "Lumbar spinal stenosis." Up to date. 22 May 2008.
