Central myelopathy in the setting of canal stenosis commonly presents with which manifestation?

• A. Gait disturbance with hyperreflexia
• B. Pure sensory loss in a dermatomal pattern
• C. Isolated neck stiffness with no neurologic signs
• D. Isolated radicular pain without gait changes

Answer: (A)

Compression of the spinal cord from canal stenosis produces upper motor neuron signs, so the most common presentation is gait disturbance with hyperreflexia. Tightening of the long tracts in the cord disrupts corticospinal pathways, leading to a spastic, unsteady gait and brisk reflexes in the legs. You may also see related signs such as clonus or a positive Babinski, and patients can notice subtle hand dexterity problems as the myelopathy progresses. Sensory changes tend to be level- or patchy rather than neatly following a single dermatomal map, and the pattern described as pure dermatomal sensory loss or isolated neck stiffness without neurologic signs points away from central myelopathy. Isolated radicular pain without gait changes likewise suggests nerve-root involvement rather than spinal cord compression.