Cervical myelopathy gait?
This is a very interesting case because there is some mystery to it, and it’s also an example of how patients and doctors can be misled, or confused by several co-existing pathologies. In this case we have a 60 year old gentleman with complaint of severe low back pain on his right side, and a problem with walking on his right leg.
I reviewed his cervical and lumbar MRI scans, and his radiology reports. As I discuss in this video, his lumbar MRI shows a mild spondylolisthesis at L4-5, and everything else in his low back looks very good, so that doesn’t really explain his low back pain severity. I asked him if he was putting heat on his low back, which can often explain such a discrepancy between lumbar pathology and pain severity, and, in fact, he said he was. So I’m mindful of that, but I am going to search for other possibilities too, because I don’t want to miss something more important.
As for his cervical MRI scan, he has a wide canal with plenty of room for his spinal cord, but he has a severe retrolisthesis at C4-5 with signigicant spurring at that level, and a cord signal change at that level, perhaps caused by extension of his neck, which pinced his cord, as can sometimes happen.
On examination, he has hyper-reflexia of his upper and lower extremities, unsustained clonus, negative Hoffman, and weakness of his left hip muscles. And on observation, his gait is atypical for an antalgic lumbar gait. Rather, he seems to have a Trendelenburg gait on the right, meaning that his leg collapses because he can’t hold his pelvis level with his left hip muscles. So his picture is mixed.
As you’ll see, I referred him for x-rays to see if his L4-5 spondylolisthesis worsens when bending, and despite my instructions, he didn’t bend properly, so I don’t have definitive information about that question.
This is the real, messy world of patient evaluation. At this point, I’m going to forward all the data to the neurosurgeon and see what he thinks about these issues.
If I can help you with your neck or back problem, call me at 404-558-4015.
