The association between intermittent neurogenic claudication and spinal sagittal balance in patients with lumbar canal stenosis: a prospective study

Neurologic claudication (NC) is one of the most common clinical symptoms in patients with spinal canal stenosis. The patient feels pain and paresthesia in his lower extremity during walking that is relieved by stooping ahead. Sagittal balance of spine is one of the most important factors in treating patients with spinal stenosis. The study was conducted to determine if neurogenic claudication has any effect on spinal sagittal balance in patients with lumbar canal stenosis. In this study we analyzed 47 patients with lumbar canal stenosis and divided them into two groups based on the presence or absence of neurogenic intermittent claudication. We put those patients without intermittent claudication in group1 (n=26; mean age: 48.3) and those who have intermittent claudication in group2 (n=21; mean age: 53.3). All patients had standing radiography of spine from C1 to S5 and sagittal C7 plumb line and distance between it and posterior superior corner of S1, kyphosis of thoracic spine and lordosis of lumbar spine were measured. Sagittal plumb line in group 2 was more anterior than group1 patients (+1mm vs. +24mm), although it was not significant (p=0.063). However, thoracic kyphosis (42.4 vs. 51.2; p= 0.003) and lumbar lordosis (27.9 vs. 43.8; p=0.00) were significantly lower in group 2. Patients with intermittent neurogenic claudication had forward posture to relief their symptoms but they tried to maintain total sagittal balance as normal as possible by straightening thoracic spine.