Intermittent medullary claudication: postmortem spinal angiographic findings in two cases and in six controls

Postmortem thoracolumbar aortography with solidifying contrast medium to visualize the arteries of the lower part of the spinal cord was performed in two patients with a long history of intermittent neurogenic claudication and degenerative spinal stenosis, as well as in six controls. One of the patients proved to have advanced atheromatous lesions in the aorta, several obliterated intercostal and lumbar arteries, and a blocked caudal portion of the anterior spinal artery. The other had an arterious malformation in the spinal cord at the thoracolumbal junction. The angiographic findings for these patients differed remarkably from those of six age-matched controls, indicating that disturbed blood flow in the lower part of the cord probably contributed to the symptom complex in the patients with claudication. The potential combination of local compression and vascular disease of the cord may explain why decompressive procedures sometimes fail to eliminate a patient's symptoms.