Is It Spinal Stenosis: Neurogenic vs Vascular Claudication

spinal stenosis neurogenic claudication shopping cart sign

What is the 'grocery cart sign'? Could it help diagnose your spinal stenosis?

Lumbar spinal stenosis can cause classic symptoms of neurogenic claudication but sometimes leg pain, numbness, and weakness are signs of circulatory problems and vascular claudication and are unrelated to narrowing of the spinal canal. Determining the real cause of pain is key to applying proper treatment and achieving pain relief and improved mobility.

Back Pain – Is it Spinal Stenosis?

Sciatica, low back pain, and pain radiating down the legs and into the feet can all be signs of spinal nerve compression and spinal stenosis. Disc herniation, osteophyte growth, and spinal slippage are all potential causes of such pinched nerves and symptoms of neurogenic claudication. Patients with symptomatic spinal stenosis usually find that they feel worse when standing for a prolonged period of time and experience low back pain relief when able to lie down or sit in such a position so as to reduce lumbar lordosis (backwards bending).

Shopping Cart Sign and Spinal Stenosis

The so-called shopping cart sign describes the common stoop of patients with lumbar spinal stenosis who either consciously or inadvertently adopt a simian-like posture that opens up the spaces in the spinal canal and relieves nerve compression.

Patients with advancing spinal stenosis will often become unable to walk long distances without the need for rest and may find that the time that they can spend standing upright is also diminished. Walking with a frame can help as this allows the arms and upper body to bear weight and for lumbosacral and hip flexion to reduce spinal stenosis symptoms. Such signs can help a physician differentiate neurogenic and vascular claudication and treat symptoms accordingly.

Check the Skin for Vascular Claudication Signs

Patients with neurogenic claudication will usually report the need to sit or lay down frequently when walking in order to relieve pain. Symptoms of lumbar spinal stenosis and neurogenic claudication are typically slow to resolve and their onset can vary in terms of distance walked or time spent standing. It is uncommon for such patients to experience changes in the skin of the legs, ankles, or feet like in vascular claudication where mottling, skin atrophy, and hair loss may occur. Pulses are often weaker in the legs and feet in vascular claudication whereas neurogenic claudication from spinal stenosis is unlikely to affect the pulse.

Leg Pain Relief in Spinal Stenosis

Vascular claudication symptoms will usually resolve quickly after the patient stops walking or standing and rests instead, whereas pinched nerves in the spine results in symptoms that take longer to subside or remain constant. A further test can be carried out to differentiate the two as vascular claudication will results in pain in patients using an exercise bike whereas the change in lumbar posture during this test results in pain relief for many patients with neurogenic claudication.

Checklist for Spinal Stenosis


There are a number of ways that a physician can determine if your leg pain is due to spinal stenosis and neurogenic claudication rather than vascular claudication:

  • Leg pain, numbness, and weakness arise when walking or standing but do not quickly resolve at rest
  • Bending forwards relieves low back pain
  • There is no pretibial hair loss or other skin changes in the legs or ankles
  • Pulses remain consistent in the distal lower limbs

Pinched Nerves or Poor Circulation?

It may be tempting to assume that leg pain and fatigue are due to spinal stenosis, especially as many people display signs of narrowing in the spine as they age. However, this is a dangerous assumption as pain medications can mask a different problem and allow it to become worse and back surgery for spinal stenosis may be suggested with little chance of success as it fails to address the actual cause of symptoms. You and your friend may both suffer with tired and painful legs when walking to the store but this does not mean that you both have spinal stenosis. Neurogenic claudication and vascular claudication are very different conditions requiring different treatments; make sure that you get an accurate diagnosis.

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