Atypical proximal limb pain of suspected high lumbar stenotic origin arising from severe aortoiliac disease--Leriche's syndrome

Abstract

We present the cases of two middle aged women who were referred to our physiatric spine center with chronic and proximal lower extremity pain complaints of suspected upper lumbar and stenotic origin. Their histories, physical examinations, and imaging studies were not convincing for a primary radicular pain generator. Non-invasive arterial Doppler studies demonstrated a significant brachial to high thigh pressure discrepancy without a focal segmental drop affecting the more distal lower extremity vasculature. Computed tomography (CT) angiograms confirmed advanced aorto-iliac atherosclerotic disease in each case. Spine practitioners are often consulted by the medical community to direct care in patients with suspected lumbar stenosis. These atypical cases of patients with isolated proximal lower extremity pain remind us of the symptomatic overlap between neurogenic and vascular claudication and emphasize the importance of a detailed history, physical examination, and appropriate imaging studies in identifying patients with primary arterial insufficiency.