Recognize neurogenic claudication and Spinal Stenosis:

Spinal stenosis means narrowing of the spinal canal leading to compression of nerves. Commonest level is L4-5.

Symptoms usually indicate that there is anatomically advanced disease.

Gluteal pain (claudication) and back of thighs are common sites of pain.

It differs from vascular claudication in some very important features.

1. Vascular claudication gets almost immediately relieved upon rest but neurogenic claudication does not.
2. Another important point is the "shopping cart support" sign. Patients with spinal stenosis feel more comfortable walking if they are not straight and erect. Whenever they go shopping, they like to lean on the shopping cart and walk in the store. Thus bicycling does not cause pain due to the stooped posture in spinal stenosis but is painful in vascular.

Diagnosis is clinical. MRI is used to confirm only if symptoms are disabling or motor weakness starts.

Treatment: Spinal exercises are critical. Weight loss is also important as is abdominal muscle strengthening.