Arthritis of the Spine - Spinal Imaging and Image Analysis - page 41

loss of sensation, often associated with numbness and tingling. When the spinal
cord is compressed, a sensory plane can be detected, separating the body into areas
with normal sensation above the plane and areas without normal sensation below
the plane. If a nerve root is affected, the sensory change is often distributed in the
skin area supplied by the compressed spinal nerve, or in other words, in a der-
matomal pattern. Patients may also experience dif culty with urination or having

bowel movements. On physical exam, patients are found to have an abnormal gait
early in the course of disease, indicating weakness of the legs. Neck motion is often
limited. Lhermitte

finding, and can be induced by bending
the neck. When this sign is present, patients experience a sensation of an electric
shock in the neck, shooting down to the arms and along the spine.
Rarely, cervical spinal stenosis presents acutely. This can happen after minor
injury or whiplash injury. These patients often have pre-existing degenerative
changes, and a minor disturbance then leads to worsening and onset of nerve
symptoms, with rapid progression of weakness, sensory changes, and bladder or
bowel dysfunction.
The common clinical presentation of lumbar spinal stenosis was well charac-
terized in a cohort of 68 patients [ 26 ]. Back pain, often travelling down the legs,
numbness, and weakness of the legs are common. A prominent feature is neuro-
genic claudication, with worsening of symptoms on walking or standing, and relief
when sitting or bending forward. On exam, patients are often found to have a wide-
based gait. Weakness and sensory changes are distributed in one or more spinal
nerve areas, indicating radiculopathy. Cauda equina syndrome is a rare complica-
tion of lumbar spinal stenosis, with weakness of both legs associated with urinary
dysfunction. If spinal stenosis occurs higher in the spine than the L1

' is sign is a characteristic

L2 level,
damage of the spinal cord will cause myelopathy, with presentation similar to that
of cervical spinal stenosis, but involving the legs.

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2.3.3 Treatment

Conservative management is the mainstay treatment for spinal stenosis. In patients
with cervical spinal stenosis, immobilization with a soft collar or a brace is often
recommended. Activities such as action sports or intense neck movements should
be avoided. Prevention of whiplash injury during motor vehicle accident is
important. For patients with lumbar spinal stenosis, although evidence is lacking,
exercise is recommended with a goal to strengthen muscles and to maintain correct
posture. Pain control with acetaminophen and NSAIDs is commonly used, and can
be escalated to opioids if needed. Epidural injection of corticosteroids is used in
lumbar spinal stenosis, but with limited evidence supporting its effectiveness.
In some cases, compression can be relieved by surgery. However, the indications
for surgery and its timing have not been well studied. Commonly, surgery is
considered in patients with progressive nerve symptoms or moderate to severe
symptoms with dif

culty performing daily tasks [ 26 ]. In patients with spinal