Narrow lumbar spinal canal with "vascular" syndromes

Symptoms suggestive of vascular origin, both venous and arterial, may be the presenting complaints in patients with lumbar spondylosis. Fourteen patients suspected of having vascular intermittent claudication were found to be free of vascular disease, but had cauda equina compromise from herniated disk, osteoarthritis, and hypertrophic ligaments. Complete follow-up data were available for seven patients. In three, claudication seemed typical; in four, atypical. At operation, herniated intervertebral disks, osteophytic bone, or hypertrophied ligamenta flava, or a combination, were found. All benefited from lumbar laminectomy. When patients with vascular-like symptoms are found to be free of arterial or venous disease, lumbar spondylosis (narrow lumbar canal syndrome) should be considered. Chronic incapacitation pain without vascular disease provides a clue, as does electromyography. Plain X-ray films of the lumbar spine do not show the abnormality; thus, myelography should be carried out even in the absence of neurologic signs.