Pain and weakness in walking due to lumbar stenosis
Claudication during walking refers to pain, numbness or weakness in the lower limbs, is intermittent when the symptoms subside a few minutes after the motion is complete and is characterized as neurogenic when it refers to radiculopathy due to stenosis in the lumbosacral spine.
Spinal stenosis is a result of degeneration of the spine and is due to: osteophytes, herniated disc, ligamentum flavum hypertrophy or to spondylolisthesis. Stenosis results in compression of structures (nerves, vessels) that pass through the spinal canal or the intervertebral foramen and can manifest as neurogenic intermittent claudication when it concerns the roots of the sciatic nerve.
Clinically, radiculopathy (pain, numbness, weakness) is caused initially by the pressure of the trophic vessels of the nerves (vasa nervorum) and subsequently by the irritation of the nerves themselves and the inflammatory reaction that follows. Most patients gradually reduce the walking distance and adopt a bowed upright posture. The pain aggravated by standing and by walking and is relieved by the sitting and/or bending position.
The conservative methods for the symptomatic relief of patients suffering from neurogenic intermittent claudication include: pharmaceutical treatment, physiotherapy, acupuncture & electroacupuncture, TENS, the use of a cane when walking, as well as, the use of a lumbar corset. Furthermore, invasive techniques are used such as: epidural infusion of steroids, symphysiolysis and neurolysis with radiofrequency. The conservative treatment can provide significant improvement to a large percentage of patients, while in other situations a multifactorial approach is needed rather than autonomous therapies.
The decision for surgical decompression of the root is only recommended when severe disability, progressive neurological deterioration or cauda equina syndrome is involved.
The contribution of acupuncture in pain and the ability to walk in patients with neurogenic intermittent claudication
Neurogenic claudication is a pathological situation that is not rare among patients who seek acupuncture as a therapy. In the pain clinics that implement acupuncture, 40% of the patients report sciatica symptoms and among those, up to 10% have imaging findings of lumbar stenosis and manifest claudication symptoms.
The acupuncture needle creates a strong stimulus that mobilizes the organisms’ homeostatic mechanisms. Clinical and laboratory research in the last decades documents the effect of acupuncture on many levels: it augments tissue blood flow (skin, muscles, nerves), it promotes the regeneration of nerve structures (neurotrophins), it affects the neural function, it suspends the sympathetic hyperactivity, it has analgesic (b-endorphines) and anti-inflammatory (CGRP, substance P, cytokines) action.
The publications of various cases and studies in a number of patients with neurogenic intermittent claudication that were treated with acupuncture reveal marked amelioration in: low back pain, sciatic pain, as well as, the walking distance; they also referred to positive results in the numbness and the weakness of the limb. The relief from pain as a main symptom is significant regardless of the claudication distance. The existing evidence shows that acupuncture can be useful in relieving patients’ pain with symptoms of claudication due to spinal stenosis.