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Neurogenic claudication (NC), also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis (LSS) and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord. [1] [2] Neurogenic means that the problem originates within the nervous system.
The thecal sac or dural sac is the membranous sheath (theca) or tube of dura mater that surrounds the spinal cord and the cauda equina. The thecal sac contains the cerebrospinal fluid which provides nutrients and buoyancy to the spinal cord. [ 1 ]
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. [6] Symptoms may include pain, numbness, or weakness in the arms or legs. [1]
In 1977, Dyck and Doyle reported on the bicycle test, a simple procedure in which the patient is asked to pedal on a stationary bicycle. If the symptoms are caused by peripheral artery disease , the patient will experience claudication, a sensation of not getting enough blood to the legs; if the symptoms are caused by lumbar stenosis, symptoms ...
Stagnation of the CSF within the thecal sac facilitates exudation from the tumour itself and activation of coagulation factors. A clinical test formerly used for evaluation of spinal stenosis is Queckenstedt's maneuver. Nowadays, a magnetic resonance imaging is used for identification of CSF flow obstruction.
Lumbar puncture is done before injected contrast into the thecal sac. However, it is dangerous to do lumbar puncture in those who have raised intracranial pressure (ICP). [3] For those who had recently done lumbar puncture in one week time, there may be some cerebrospinal fluid (CSF) accumulates in the subdural space.
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Intradural disc herniation occurs when the disc material crosses the dura mater and enters the thecal sac. It is a rare form of disc herniation with an incidence of 0.2–2.2%. Pre-operative imaging can be helpful for diagnosis, but intra-operative findings are required for confirmation. [26]
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