Comprehensive Osteopathic Medical Licensing Examination (COMLEX USA) Practice

What is NOT a typical symptom associated with spinal stenosis?

1. Worsening pain with extension

2. Improvement of symptoms with flexion

3. Sudden neurological changes

4. Poorly localized pain

The correct answer is: Sudden neurological changes

Spinal stenosis typically manifests with specific symptoms due to the narrowing of the spinal canal, which often leads to increased pressure on the spinal cord and nerve roots. Among the hallmark features of spinal stenosis is that patients frequently experience worsening pain with extension of the spine, as this position further narrows the already constricted space and can exacerbate the compression on neural structures. Conversely, flexion tends to alleviate symptoms, as it opens up the spinal canal and reduces pressure. Poorly localized pain can occur in spinal stenosis, but it is often more characteristic of pain radiating from the affected nerves, such as sciatica due to lumbar stenosis. Sudden neurological changes are not typical in spinal stenosis. Instead, symptoms usually develop gradually over time as the condition progresses, with chronic pain and varying degrees of neurological compromise being more typical. Therefore, the presence of sudden neurological changes would suggest a different or more acute pathology, such as a herniated disc or an acute spinal injury, rather than the chronic condition associated with spinal stenosis. This distinction reinforces why sudden neurological changes do not align with the expected symptom profile for this condition.