Differences Between Vascular and Neurogenic Claudication

Claudication is a possible cause of muscular pain, most commonly in the legs. This symptom can be considered either vascular or neurogenic. Understanding the differences between vascular and neurogenic claudication is an important step toward achieving pain relief. 

Understanding Neurogenic Claudication vs. Vascular Claudication

Claudication is characterized by pain in certain muscles during physical activity. It most often affects the hips, buttocks, thighs, calves, or feet. But, claudication can instead impact the forearms, biceps, and shoulders, depending on its root cause. 

What is Vascular Claudication?

Vascular claudication is widely known as one of the symptoms of peripheral artery disease. This means that it’s triggered by poor blood flow to the muscles as a result of arterial damage.

Peripheral Artery Disease

Peripheral artery disease, or PAD, is a circulatory condition that occurs when plaque builds up in the peripheral arteries (the large arteries that send blood to the arms and legs) and causes damage. Plaque consists of cholesterol and fats. When it accumulates in the arteries, it limits the flow of blood (and, therefore, oxygen and nutrients) to the muscles. 

Limited circulation to the muscles often doesn’t cause symptoms when the patient is at rest. However, when the patient uses the muscles that are receiving limited blood flow, pain can result. This muscular pain with activity is referred to as claudication, while the buildup of plaque in the arteries is known as atherosclerosis. 

Risk Factors For Vascular Claudication

The key risk factors for vascular claudication include:

  • Being older than 70 years of age
  • Smoking
  • Having diabetes
  • Having a family history of claudication, peripheral artery disease, or atherosclerosis
  • Having high blood pressure or high cholesterol
  • Being obese (BMI over 30)

What is Neurogenic Claudication?

Neurogenic claudication refers to muscle pain caused by nerve compression in the lumbar (lower) spine. It can also be called pseudoclaudication. 

There are several possible causes of lumbar nerve compression that lead to neurogenic claudication. These include:

  • Spinal stenosis

Spinal stenosis is the most common cause of neurogenic claudication. This spinal condition results from abnormal constriction of the space in the spinal canal. As the space in the spine becomes more limited, it may trigger nerve compression and neural claudication. 

Along with neural claudication, spinal stenosis can cause:

  • Pain in the neck or lower back 
  • Weakness, tingling, and/or numbness in the extremities
  • Cramping in the legs
  • Herniated disc

A herniated disc is a spinal injury that occurs when the exterior of an intervertebral disc becomes damaged. The soft interior of the disc may protrude through a break in the disc exterior. If the damaged disc presses on spinal nerves, pain and neurological symptoms (like weakness, tingling, and numbness in the legs or feet) can occur. 

Neurogenic claudication is a possible symptom of a herniated disc. In most cases, the herniated disc leads to spinal stenosis, which then triggers neurogenic claudication. 

  • Bone spurs 

Bone spurs are hard, smooth growths made out of bone tissue. Age-related spinal degeneration can break down the cartilage that prevents friction between the bones of the spine. As a result, bone spurs can form. 

Again, bone spurs can reduce the space in the spinal canal, leading to spinal stenosis. Neurogenic claudication may then develop as a result.  

  • Spondylolisthesis  

Spondylolisthesis is a spinal condition that’s characterized by instability. With this condition, the bones of the spine move more than usual and one of the vertebrae slips out of its usual position. The displaced vertebra then lands on the vertebra beneath it. 

The poor alignment of the vertebrae with spondylolisthesis can bring about neural claudication and other symptoms including:

  • Spasms in the hamstring muscle of the thigh
  • Stiffness and lost range of motion in the back
  • Back pain, namely while bending forward
  • Worsened pain while walking or standing for a long time
  • Weakness, tingling, and/or numbness in the lower extremities

Claudication: Neurogenic vs. Vascular

While neurogenic claudication involves the nervous system, vascular claudication involves the circulatory (or vascular) system. 

Since neurogenic and vascular claudication are rooted in different bodily systems, they’re treated differently. 

Treatment: Vascular vs. Neurogenic Claudication

How is Vascular Claudication Treated?

Since vascular claudication is often a sign of peripheral artery disease or related conditions, prompt treatment is essential. In most cases, your doctor will first recommend non-surgical treatments to manage this condition, such as:

  • Stopping tobacco use, which is among the largest risk factors for vascular claudication.
  • Adding walking to your regular routine. Walking is the optimal exercise for claudication and peripheral artery disease. 
  • Taking prescription medications, such as antiplatelet, blood pressure, and cholesterol medications. 

In severe cases of vascular claudication that aren’t improved with conventional treatment, vascular surgery may be recommended. In this surgical procedure, a blood vessel that’s in good condition is first taken from an area of the body. That blood vessel is then used to replace the claudication-causing vessel, which restores the patient’s healthy blood flow. 

How is Neurogenic Claudication Treated?

Patients experiencing neurogenic claudication will first be recommended to undergo non-surgical treatments, such as:

  • Anti-inflammatory medications

Medications can help patients manage pain and reduce inflammation from neurogenic claudication. However, in many cases, medications aren’t a long-term treatment option

  • Physical therapy

A trained physical therapist can help alleviate tension, strengthen the supportive muscles of the spine, and promote spinal alignment. Your physical therapist may recommend exercises to help treat neurogenic claudication, as well as hot/cold therapy, massage therapy, acupuncture, and other alternative therapies. 

  • Epidural steroid injections

Steroid injections can provide short-term pain relief for patients struggling with neurogenic claudication. However, patients should only undergo a few injections per year. 

  • Lifestyle modifications

Rest, a healthy diet, quitting smoking, and low-impact exercise can help patients manage neurogenic claudication and recover from spinal disorders. Maintaining a healthy weight can also help in the treatment of this condition by reducing the impact on the spine with daily activities. 

Spinal Surgery For Neurogenic Claudication

If patients don’t respond to several months of non-surgical treatments, spine surgery may be suggested. Surgical neurogenic claudication treatment typically involves spinal decompression.

What is Spinal Decompression Surgery?

Spinal decompression is a term used to describe many different surgical methods. All of these methods share a goal: to alleviate spinal nerve compression. Examples of spinal decompression procedures include laminectomy, laminotomy, foraminotomy, and discectomy. 

Spinal Fusion Alternatives

Patients looking to avoid spinal fusion in surgery to resolve neurogenic claudication have other options. Spinal implants, such as the TOPS System, stabilize the spine without fusing the affected vertebrae. Instead, the implant moves with the spine, allowing the patient to bend and twist after the procedure. 

The TOPS System also allows for minimally-invasive surgery in neurogenic claudication treatment. This means that patients will enjoy a shorter recovery period, less pain after the surgery, and a lower risk of medical complications.

Conclusion: Neurogenic vs. Vascular Claudication

Neurogenic claudication and vascular claudication are unique conditions with different causes and treatments. Patients suffering from neurogenic claudication who are recommended to undergo spinal surgery may consider fusion alternatives, such as the TOPS spinal implant, to avoid losing spinal flexibility.