Spinal canal stenosis: differential diagnosis

Vascular claudication

• There is usually no history of back pain or injury with vascular claudication
• Pain is in the calf: it is in the buttock, thigh or leg in spinal claudication
• It is worse walking uphill: it is better going uphill with spinal claudication
• Cycling provokes pain unlike with spinal claudication
• Pain is relieved by standing still or stopping exercise: spinal claudication is provoked by standing
• Relief of pain occurs within 15 seconds of resting: it takes 5-15 minutes with spinal claudication
• The claudication distance is constant: it is variable in spinal claudication
• There is a stocking sensory loss: it is segmental in spinal claudication
• It is not provoked by Valsalva: unlike with spinal claudication
• There are abnormal foot pulses in vascular claudication
• There are arterial bruits in vascular claudication

Lateral disc prolapse

Other differentials

References

1. Hawkes CH, Roberts GM. Neurogenic and vascular classification. J Neurol Sci 1978; 38:337-345.
2. Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology. Lippincott Williams & Wilkins Philadelphia 2007 p96.
3. Dyck P, Doyle JB Jr. “Bicycle test” of van Gelderen in diagnosis of intermittent cauda equina compression syndrome: case report. J Neurosurg 1977; 46:667-670.
4. Mazanek DJ, Podichetty VK, Hsia A. Lumbar canal stenosis: start with nonsurgical therapy. Cleve Clin J Med 2002; 69:909-917.
5. Fagius J, Wedterberg CE. Pseudoclaudication syndrome caused by a tumour of the cauda equina. JNNP 1979; 42:187-189.
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Related checklists

• Spinal canal stenosis: clinical features
• Spinal canal stenosis: assessment and management