How do central canal stenosis and foraminal stenosis differ in symptomatology?

• A. Central stenosis causes radicular symptoms; foraminal stenosis causes myelopathy
• B. Central stenosis causes cord/myelopathy symptoms; foraminal stenosis causes radicular nerve root symptoms
• C. Both conditions produce only pain
• D. Central stenosis causes neuropathy in limbs; foraminal stenosis causes brain symptoms

Answer: (B)

The main idea is where the compression occurs and which neural structure is affected. Central canal stenosis narrows the spinal canal and presses on the spinal cord (or cauda equina in lower levels), leading to myelopathic symptoms. That means signs of spinal cord dysfunction such as bilateral motor and sensory changes, gait disturbance, hyperreflexia or other upper motor neuron findings, and in cervical cases of hand dexterity problems. In the lumbar region, it can cause neurogenic claudication with pain and weakness in both legs that worsens with standing or walking and improves with flexion.

Foraminal stenosis, on the other hand, narrows the opening where a nerve root exits the spine, so it compresses a specific exiting nerve root. This produces radicular symptoms: sharp or shooting pain, numbness, and weakness in the dermatomal distribution of that root, often unilateral and related to the particular myotome and dermatome involved. Reflex changes may reflect the affected root.

So the central canal compression tends to produce cord or cauda equina-type, myelopathic symptoms, while foraminal compression leads to radicular nerve root symptoms. If both coexist, you can see a mix, but the pattern still tracks with the level and structure compressed.