Spinal, also called neurogenic, claudication is common, and in the elderly it is almost invariably caused by degenerative disease of the lumbar spine. There are, however, a few rare but important other causes that should be considered, as in this case.

THE STORY

A 77-year-old lady presented with a four-year history of progressive difficulty walking because of leg pain, predominantly in her calves, that was relieved by sitting down or leaning forwards on her trolley frame. She required one stick to mobilise at the onset of her symptoms, progressing to two sticks 18 months before presentation, and at presentation she was only able to walk a few metres with the aid of a frame. She also reported some numbness in her calves and gave a two-year history of urinary urgency and occasional urge incontinence; her bowels were not affected. The patient had significant vascular risk factors, with a 17-year history of type II diabetes mellitus, treated with insulin for the previous five years, hypertension, hypercholesterolaemia and a body mass index of 36.

On examination, she walked with short steps, for a distance of about 5 m, being limited by pain. Rhomberg’s test was negative. Tone was normal in all her limbs but there was mild proximal …