EpistemisNeurogenic claudication
Specialty: Musculoskeletal.
Why it occurs
- Lumbar spinal canal stenosis (canal stenosis due to hypertrophy of the yellow ligament and facet osteoarthritis)
- Spondylolisthesis with associated foraminal stenosis
- Massive central disc herniation
- Paget's disease of bone with lumbar vertebral involvement
- Facet synovial cysts that compress the dural sac
- Congenital narrow lumbar canal exacerbated by degenerative changes
Initial workup
Lumbar spine magnetic resonance (method of choice to measure the diameter of the dural and foraminal canal) | Computed tomography (CT) of the lumbar spine with bone reconstruction | Electromyography of the lower extremities to quantify radicular distress.
red flags
Sudden loss of sphincter control (urinary or fecal incontinence), saddle anesthesia (loss of perineal sensitivity), progressive weakness in bilateral foot dorsiflexion (cauda equina syndrome, surgical emergency).
Standard management
- Pregabalin — 75-150 mg every 12 hours orally; neuropathic pain modulator
- Gabapentin — 300-600 mg every 8 hours orally
- Tramadol — 50 mg combined with paracetamol 325 mg orally every 8 hours
- Epidural infiltration of corticosteroids (caudal, transforaminal or interlaminar) for medium-term symptomatic control.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4