Intermittent spinal claudication

Classification according to ICD-10
M48.06 + G55.3 *	Spinal canal stenosis, lumbar region
ICD-10 online (WHO version 2019)

Spinal claudication (more rarely also intermittent claudication ) is the Latin term for a pain syndrome caused by narrowing of the spinal canal in the lumbar spine (lumbar spine).

root cause

In the spinal canal (almost) all nerve tracts run between the head and the trunk. In the lumbar spine area, it is still all the nerve tracts that affect the legs and abdomen. When the spinal canal is narrowed, these nerve structures become trapped. While the spinal canal genes in the cervical and thoracic spine areas pinch the spinal cord and lead to paraplegia , there is no spinal cord in the lumbar spine, only individual nerve cords, and the main problem is "only" pain.

The most common cause is the degeneration of the facet joints ("wear and tear", osteoarthritis) and the yellow ligament. These become thicker and thicker over the course of years or decades and take away the nerves' space, which initially remains unnoticed for a long time. From the moment there is no more space left, the pressure on the nerves increases and the claudication becomes noticeable.

Other diseases that can narrow the spinal canal include: B. very large herniated discs or tumors or high-grade "sliding vertebrae", but this is rather rare.

Symptoms

It comes to the so-called "intermittent claudication" (claudication). There is typically severe pain in the legs when walking, forcing you to take breaks from walking, which eases the pain and allows you to walk a few more meters until the leg pain gets worse. This is known as intermittent (occurring at times or intermittently). A key question the doctor will ask is "How many meters can you walk before you have to stop?"

The disease develops very slowly, but the progression becomes faster and faster the shorter the walking distance.

Back pain , especially facet syndrome , is a common accompanying symptom, but leg pain (usually bilateral) is typical and essential.

Sensory disturbances in the legs can also occur, but do not have to be.

It is typical that the patient does not have any complaints when he is at rest (lying down, sitting) and that the medical examination does not find anything abnormal at first (apparently completely healthy patient).

It is typical that the symptoms get better by bending forward. In advanced disease, straightening the body is difficult and / or painful.

It is typical that the symptoms only occur when walking, but not when cycling.

If left untreated, the disease means that at some point you can no longer walk at all.

Diagnosis

After suspecting a narrowing of the spinal canal in a medical consultation and medical examination, the next step is an MRI of the lumbar spine. This clearly proves or disproves the suspicion. If an MRI is not possible (e.g. if you have a pacemaker), you have to resort to less optimal imaging methods such as CT or myelography . X-rays are unfortunately completely useless in this context.

treatment

You can see the symptoms with painkillers and physiotherapy alleviate, but the only causative treatment is surgery . There is no room for the nerves; some of the bones, joints, and ligaments of the spine must be removed to correct the condition.

One can lose the ability to walk if the condition is not treated, while the risk of surgery is relatively low these days. Advice regarding a narrowing of the spinal canal should therefore only be given by a specialist in spinal surgery. These are mostly trauma surgeons, orthopedic surgeons and neurosurgeons. In turn, you should be skeptical if you are offered a stiffener in addition to the expansion of the spinal canal , which is usually not necessary, but brings almost twice as much money.

Differential diagnostics

If the MRI of the lumbar spine is normal, spinal claudication is excluded and other diseases should be considered.

A disease that has almost exactly the same symptoms is "real" intermittent claudication , caused by peripheral arterial occlusive disease , ie a narrowing of the arteries of the legs (so-called "smoker's leg"). However, these complaints a) also occur when cycling, b) the doctor cannot feel any foot pulses during the examination , and c) there is no relief by bending over.

Hip joint wear can cause similar pain, but the details are different, and the experienced examiner can easily distinguish between them.

Insertion tendons , polyneuropathy and the like a. m. can cause similar symptoms as well.

In rare cases, claudication can also be the side effect of medication that leads to muscle pain and calf cramps.

literature

• Wolfgang Müller, Henning Zeidler : Differential diagnosis of rheumatic diseases. 3rd completely revised and expanded edition, Springer Verlag Berlin Heidelberg, Berlin Heidelberg 1998, ISBN 978-3-662-06713-0 .
• Andreas Hufschmidt, Carl Hermann Lücking, Sebastian Rauer (Eds.): Neurology compact. For clinics and practices, 6th revised and expanded edition, Thieme Verlag 2013, ISBN 978-313-117196-2
• Bernd Hölper, Michael Eichler: Compendium of neurosurgery and spinal column surgery, pro INN-Verlag, 2012, ISBN 978-300-034300-1 .

Web links

• Guidelines of the German Society for Orthopedics and Orthopedic Surgery (accessed on January 11, 2016)

Individual evidence

1. ↑ Jenny Grünert: CODING AND REMUNERATION IN THE STATIONARY SUPPLY MAIN DEPARTMENT 2016. Medtronic GmbH, accessed on July 3, 2020 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !