Spinal stenosis presenting with scrotal and perianal claudication

Area of Science:

• Neurosurgery
• Radiology
• Orthopedics

Background:

• Neurogenic claudication typically manifests as leg pain.
• Atypical presentations, such as scrotal and perianal pain, are uncommon but possible.
• Severe spinal stenosis can compress neural structures, leading to varied symptoms.

Purpose of the Study:

• To highlight an unusual presentation of neurogenic claudication.
• To emphasize the importance of considering spinal stenosis in patients with perianal/scrotal pain.
• To report successful surgical management of severe spinal stenosis causing atypical symptoms.

Main Methods:

• A case report of a 63-year-old gentleman with a one-year history of progressive neurogenic claudication.
• Magnetic resonance imaging (MRI) to diagnose severe central canal stenosis.
• Surgical decompression (L3/4, L4/5) and transforaminal lumbar interbody fusion.

Main Results:

• The patient experienced neurogenic claudication presenting as scrotal and perianal pain, exacerbated by walking/standing and relieved by sitting.
• MRI confirmed severe central canal stenosis.
• Post-operative recovery was good, with immediate resolution of symptoms.

Conclusions:

• Spinal stenosis should be considered in the differential diagnosis of perianal and scrotal claudication, even without leg symptoms.
• MRI is crucial for diagnosing spinal stenosis.
• Surgical decompression offers predictable good results for severe cauda equina compression presenting with these rare symptoms.