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spinal canal due to osteophytosis of the posterior vertebral bodies or to narrowing of the intervertebral foramina due to osteoarthropathy at the apophyseal joints; thickening of the ligaments (both the ligamentum avum posteriorly and the posterior longitudinal ligament anteriorly) adds to the narrowing of the canal However, only half of the patients with radiologic abnormalities showed physical signs of root or cord involvement (changes in the tendon re exes in the arms, briskness of re exes and impairment of vibratory sense in the legs, and sometimes Babinski signs) The occasional nding of a Babinski sign in older individuals who had never had a stroke or complained of neurologic symptoms is often explained by an otherwise inevident cervical osteophyte (Savitsky and Madonick) The pain is usually centered at the base of the neck or higher, often radiating to an area above the scapula When brachialgia is also present, it takes several forms: a sharp pain in the pre- or postaxial border of the limb, extending to the elbow, wrist, or ngers; or a persistent dull ache in the forearm or wrist, sometimes with a burning sensation Discomfort may be elicited by coughing, Valsalva maneuver, or neck extension, or neck exion may induce electrical feelings down the spine (Lhermitte symptom) Rarely, the pain is referred substernally As to the sensory disorders (which may occasionally be absent), numbness, tingling, and prickling of the hands and soles of the feet and around the ankles are the most frequent complaints Some patients complain of numbness or paresthesias, most often in one or two digits, a part of the palm, or a longitudinal band along the forearm Slight clumsiness or weakness of a hand is another complaint A feeling as if wearing gloves, swollen, or the hands coated with glue are common descriptions Several of our patients complained of paresthesias in the distal limbs and trunk for months before there was any indication of motor involvement In advanced cases there may be a vague sensory level at or just above the clavicles Impaired vibratory sensation and diminished position sense in the toes and feet (all indicative of a lesion of the posterior columns) as well as the Romberg sign are the most conspicuous sensory ndings This imparts a tabetic unsteadiness to the gait in advanced cases These sensory defects tend also to be asymmetrical (it is noteworthy that symmetric sensory symptoms and signs of identical type are seen with subacute combined degeneration due to B12 de ciency) Rarely, the sensorimotor pattern takes the form of a Brown-Sequard syndrome Less frequently, paresthesias and dysesthesias in the lower extremities and trunk may be the principal symptoms; even less often there are sensory complaints on the face, ostensibly corresponding to compression of the trigeminal sensory tract in the upper cervical cord The third part of the typical syndrome, spastic legs from a compressive myelopathy, most often presents as a complaint of weakness of a leg and slight unsteadiness of gait The whole leg or the quadricep feels stiff and heavy and gives out quickly after exercise Mobility of the ankle may be reduced, and the advancing toe of the shoe scrapes the oor On examination, hypertonicity is more evident than weakness, and the tendon re exes are increased (ankle jerks may not share in this change in the elderly) Although the patient may believe that only one leg is affected, it is commonly found that both plantar re exes are extensor, the one on the side of the stiffer leg being more clearly so Less often both legs are equally affected As the compression continues, walking becomes unsteady because of the addition of sensory ataxia The biceps and brachioradial re exes on one or both sides may be depressed, sometimes in association with an increase in the triceps and nger re exes The hand or forearm muscles, may un-.

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