Compressed nerves in the lumbar spine can cause leg pain and cramps

By Anne Asher, CPT 

 Medically reviewed by David Kesselman, DC

Neurogenic claudication occurs when spinal nerves get compressed in the lumbar (lower) spine, causing intermittent leg pain. Also known as pseudoclaudication, it typically occurs when the space within the bones of the lumbar spine gets too small—a condition referred to as lumbar spinal stenosis.

The term neurogenic claudication is sometimes used interchangeably with spinal stenosis. However, neurogenic claudication is a syndrome (a group of symptoms) caused by a pinched spinal nerve, while spinal stenosis describes the narrowing of the spinal passageway.

This article describes the symptoms and causes of neurogenic claudication, as well as how the condition is diagnosed and treated.

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Neurogenic Claudication Symptoms

Neurogenic claudication is characterized by nerve pain, typically in both legs. Although there may also be pain in the lower back or buttocks, the pain will be more specific to the legs.

Symptoms of neurogenic claudication include:

  • Sharp, shooting, or aching pain extending into the lower extremities

  • Numbness, tingling, or burning sensations

  • Leg fatigue and weakness

  • A sensation of leg heaviness

  • Leg cramping

What distinguishes neurogenic claudication from other types of leg pain is that the pain is intermittent and worsens with specific movements or activities. On the one hand, standing, walking, descending stairs, or flexing the spine backward can trigger pain. On the other, sitting, climbing stairs, or leaning forward tends to relieve pain.

Over time, neurogenic claudication can affect a person's mobility as they avoid any activity that causes pain, including exercise, lifting heavy objects, and prolonged walking.

In severe cases, neurogenic claudication can make sleeping difficult and can even lead to the loss of bladder or bowel control due to the compression of nerves that regulate these functions.

Causes

With neurogenic claudication, compressed spinal nerves are the underlying cause of leg pain. In the majority of cases, lumber spinal stenosis (LSS) is the cause of pinched nerve.

There are two types of LSS. Central stenosis is the main culprit in neurogenic claudication. With this type, there is a narrowing of the central canal of the lumbar spine that houses the spinal cord. This causes pain in both legs.

LSS can either be acquired (something that develops in later life due to deterioration of the spine) or congenital (something you are born with). Each can lead to neurogenic claudication in slightly different ways.

Foramen stenosis, the other type of LSS, is the narrowing of spaces on either side of the lumbar spine where nerve roots branch off from the spinal cord. Associated pain differs in that it is either in the right or left leg. The pain corresponds to the side of the spinal cord where nerves are being pinched (known as radiculopathy).

Acquired LSS

LSS is generally acquired due to the degeneration of the lumbar spine. The causes of the narrowing of the spinal canal are many and include:

  • Spinal trauma, such as from a car accident or other injury

  • Spinal disc herniation: The bulging of cushioning discs between spinal bones (vertebra)

  • Spinal osteoporosis: Also known as "wear-and-tear" arthritis

  • Ankylosing spondylitis: A type of inflammatory arthritis affecting the spine

  • Osteophytes: Also known as bone spurs

  • Spinal tumors: Benign (non-cancerous) tumors and malignant (cancerous) ones

Because it is largely aging-related, LSS tends to affect older adults, particularly those in their 60s and 70s.

Congenital LSS

With congenital LSS, a person is born with subtle abnormalities of the spine that may not be readily apparent at birth. But, because the space within the canal is already narrow, the spinal cord is vulnerable to any changes that can occur as the person gets older.

Even if a person only has mild arthritis, they can experience symptoms of neurogenic claudication years before people with normal spines do. As a result, people with congenital LSS tend to develop symptoms in their 30s and 40s rather than their 60s and 70s.

Congenital LSS is also common in people with achondroplasia (the most common cause of dwarfism) due to the smaller size of their spine.

Neurogenic Claudication vs. Vascular Claudication

Neurogenic claudication should not be confused with vascular claudication in which blood flow to the arms or legs is severely restricted, causing pain (usually in one limb).

How Neurogenic Claudication Is Diagnosed

There is no gold standard for the diagnosis of neurogenic claudication. The diagnosis is largely based on the person's medical history, a physical exam, and medical imaging.

The physical exam and review are aimed at identifying where the pain is felt and when. Your healthcare provider may ask:

  • Is the pain constant or does it come and go?

  • Do certain movements or activities cause pain?

  • Does the pain get better or worse when you are standing or sitting?

  • Is the pain in one leg or both?

  • Do you have a history of lower back pain?

  • Do you experience any usual sensations while walking?

Your healthcare provider will likely order imaging tests to see if there are any signs of LSS.

While a spinal X-ray or computed tomography (CT) scan is useful in diagnosing LSS, a magnetic resonance imaging (MRI) scan is preferred because it is better able to image soft tissues, such as those of the spinal cord.

Treatment of Neurogenic Claudication

Treatment for neurogenic claudication usually begins conservatively with pain medications, physical therapy, occupational therapy, and, in severe cases, steroid injections. Back surgery is considered a last resort.

Pain Medications

Pain medications are commonly used to treat intermittent neurogenic claudication. These include over-the-counter analgesics like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen).

If needed, prescription NSAIDs like Celebrex (celecoxib) may be prescribed.

Medication Warning

NSAIDs are used judiciously in people with chronic neurogenic pain and should only be used when needed. The long-term use of NSAIDs can increase the risk of stomach ulcers, while the overuse of Tylenol can lead to liver toxicity and liver failure.

Physical and Occupational Therapy

The treatment plan will typically involve physical therapy. This includes daily stretching, strengthening, and aerobic exercises that can help improve and stabilize your lower back muscles and correct problems with posture.

Occupational therapy can help modify activities that cause pain. This includes teaching proper body mechanics, energy conservation methods, and how to recognize pain signals to avoid overexertion.

Supportive tools like back braces or belts may also be recommended.

Spinal Steroid Injection

If these conservative measures fail to provide relief, your healthcare provider may recommend an epidural steroid injection. With this, a steroid called cortisone is delivered to the outermost section of the spinal column called the epidural space.

For people with intermittent neurogenic claudication pain, injections like these can provide pain relief for anywhere from three to 36 months.1

Back Surgery

If all of these treatments fail and your mobility and/or quality of life are greatly impaired, a type of back surgery known as a laminectomy can be used to decompress the lumbar spine.

The procedure may be performed laparoscopically (with tiny incisions and pen-like scopes and surgical instruments) or as open surgery (with a scalpel and sutures).

During a laminectomy, facets of the vertebra are either partially or completely removed. To aid with stability, the bones are sometimes fused with screws, plates, or rods and pieces of bones harvested from the pelvis.

Laminectomy Success Rates

Success rates for open and laparoscopic laminectomy are more or less the same. Between 85% to 90% of people who undergo the surgery achieve long-lasting or even permanent pain relief.2

Summary

Neurogenic claudication is when nerves get pinched within the center of the lumbar spine, causing intermittent leg pain. It is a characteristic feature of spinal stenosis, in which the passages inside the lumbar spine get narrow. The pain typically gets worse with specific movements or activities like standing, sitting, or bending backward.

The treatment of neurogenic claudication is typically conservative and may involve oral painkillers, physical therapy, occupational therapy, or, in severe cases, spinal steroid injections. Back surgery is a last resort when all other options fail.

Sources

Munakomi S, Foris LA, Varacallo M. Spinal Stenosis And Neurogenic Claudication. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

Ma X-L, Zhao X-W, Ma J-X, Li F, Wang Y, Lu B. Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. International Journal of Surgery. 2017;44:329-338. doi:10.1016/j.ijsu.2017.07.032

Ammendolia C. Degenerative lumbar spinal stenosis and its imposters: three case studies. J Can Chiropr Assoc. 2014 Sep;58(3):312–9.

Additional Reading

Meyer B, et al. Percutaneous Interspinous Spacer vs Decompression in Patients with Neurogenic Claudication: An Alternative in Selected Patients? Neurosurgery. 2018.

Nadeau, M., M.D. The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation. Can J Surg. Dec. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859778/

North American Spine Society (NASS). Diagnosis and treatment of degenerative lumbar spinal stenosis. North American Spine Society. 2011.

  • Comer, C., et. al. Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. BMC Musculoskeletal Disorders 2009.

  • Smith, M. et.al. Schwartz’s Surgery. Chapter 42. Neurosurgery. McGraw-Hill Medicine. May 2010.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.