My wife went to the doctor because of low back and leg pain. She came home with a neck problem she didn’t even know she had. They say she has stenosis in both places. What happens next?

In spinal stenosis, there is a narrowing of the spinal canal, which surrounds the spinal cord. Anything that narrows this space can put pressure on the spinal cord causing a condition called myelopathy. Patients with lumbar pain from stenosis often have similar changes in the upper spine that have not been identified yet.

The Hoffmann sign is used by examiners assessing patients with symptoms of myelopathy (spinal cord compression). The test is done by quickly snapping or flicking the patient’s middle fingernail. The test is positive for spinal cord compression when the tip of the index finger, ring finger, and/or thumb suddenly flex in response.

The authors suggest performing the Hoffmann test on patients with low back and/or leg pain, especially when lumbar spinal stenosis is present. It is a reliable way to test for early signs of cervical myelopathy. A positive Hoffmann sign on both sides warrants imaging of the cervical spine. Anyone with evidence of cervical cord compression but no outward symptoms should be followed regularly. Routine neurologic exams every six months are advised.

Treatment of the cervical portion may not be needed. But if the person ever needs surgery, the anesthesiologist will need to know about the cervical stenosis. Position of the neck required during intubation to keep the airway open must be modified in such cases.

In the meantime, conservative care for the low back and leg pain can be started. The physician may recommend nonsteroidal antiinflammatory drugs (NSAIDs) to start. Physical therapy to help with posture, strength, and pain management may be helpful. Steroid injections have also been shown to help many patients with this condition.

If satisfactory results aren’t achieved in three to six months, then surgery may be needed. The procedure is called decompression. Pressure is taken off the spinal cord by removing bone and soft tissue pressing on the spinal cord.

And if the cervical stenosis starts to cause symptomatic myelopathy, then similar measures can be taken for the neck area.