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Neurogenic Claudication: a Review of Current Understanding and Treatment Options

  • Neuropathic Pain (A Abd-Elsayed, Section Editor)
  • Published:
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Abstract

Purpose of Review

With an aging population and increased prevalence of the disease, we set out to evaluate the validity of current diagnostic criteria for neurogenic claudication as well as the efficacy of the treatment options for the main cause, lumbar spinal stenosis (LSS).

Recent Findings

Epidural steroid injections (ESI) were most efficacious when the injectate is a steroid combined with lidocaine or lidocaine only. There are promising results regarding the efficacy of the minimally invasive lumbar decompression (MILD) procedure as well as interspinous process spacers (IPS) compared to surgical alternatives. Spinal cord stimulators are gaining ground as an effective alternative to surgery in patients with lumbar spinal stenosis that is not responsive to conservative measures or epidural injections.

Summary

We found that there continues to be a lack of consensus on the diagnostic criteria, management, and treatment options for patients with LSS. The Delphi consensus is the most current recommendation to assist clinicians with making the diagnosis. Physical therapy, NSAIDs, gabapentin, and other conservative therapy measures are unproven in providing long-lasting relief. In patients with radicular symptoms, an ESI may be indicated when a combination of lidocaine with steroids is used or using lidocaine alone. In addition, there is not enough high-quality evidence to make a recommendation regarding the use of MILD versus interspinous spacers for neurogenic claudication. There remains a need for high-quality evidence regarding the efficacy of different conservative treatments, interventional procedures, and surgical outcomes in patients with neurogenic claudication in LSS.

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Authors and Affiliations

  1. Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL, 60657, USA

    Shadi Messiah, Antony R. Tharian, Kenneth D. Candido & Nebojsa Nick Knezevic

  2. Department of Anesthesiology, University of Illinois, Chicago, IL, USA

    Antony R. Tharian, Kenneth D. Candido & Nebojsa Nick Knezevic

  3. Department of Surgery, University of Illinois, Chicago, IL, USA

    Kenneth D. Candido & Nebojsa Nick Knezevic

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  1. Shadi Messiah
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  2. Antony R. Tharian
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Correspondence to Nebojsa Nick Knezevic.

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Messiah, S., Tharian, A.R., Candido, K.D. et al. Neurogenic Claudication: a Review of Current Understanding and Treatment Options. Curr Pain Headache Rep 23, 32 (2019). https://doi.org/10.1007/s11916-019-0769-x

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