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Comparison of vascular with neurogenic claudication | ||
Evaluation | Vascular | Neurogenic |
Claudication | Fixed | Variable distance |
Relief of pain | Standing | Sitting - flexed |
Walk uphill | Pain | No pain |
Bicycle ride | Pain | No pain |
Type of pain | Cramp | Numbness, ache |
Tightness | Sharp | |
Pulses | Absent | Present |
Bruit | Present | Absent |
Skin | Loss of hair | Normal |
Shiny | ||
Leg atrophy | Rarely | Occasional |
Weakness | Rarely | Occasional |
Backpain | Uncommon | Common |
Limitation of spine | Uncommon | Common |
Movement |
Because the primary complaint often is back pain and some leg pain, pain relief after surgery may not be complete. Most series report a 64% to 91% rate of improvement, with 42% in patients with diabetes, but most patients still have some minor complaints, usually referable to the preexisting degenerative arthritis of the spine. Neurological findings, if present, improve inconsistently after surgery. In a series reported by Guigui et al., only 30% had complete improvement in motor symptoms after laminectomy, with 58% regaining grade 4 strength or better at a mean follow-up of 3 years. Reoperation rates vary from 6% to 23%. Prognostic factors include better results with a disc herniation, stenosis at a single level, weakness of less than 6 weeks' duration, monoradiculopathy, and age younger than 65 years. Reversal of neurological consequences of spinal stenosis seems to be a relative indication for surgery unless the symptoms are acute.