Can cervical stenosis cause difficulty walking?

Cervical Stenosis and Gait Disturbance

Yes, cervical stenosis can cause significant trouble walking due to spinal cord compression affecting motor pathways that control lower extremity function. 1

Pathophysiology of Gait Disturbance in Cervical Stenosis

Cervical stenosis causes walking difficulties through several mechanisms:

• Spinal Cord Compression: Narrowing of the cervical spinal canal leads to direct compression of the spinal cord, affecting the corticospinal tracts that control voluntary movement of the legs 1

• Myelopathy Development: Progressive compression results in cervical spondylotic myelopathy, characterized by:

  • Wide-based, unsteady gait
  • Progressive muscle weakness in the legs
  • "Inverted champagne bottle" appearance of legs due to muscle atrophy
  • Loss of proprioception and vibratory sensation 1, 2

• Tethered Cord Syndrome: Persistent compression can lead to metabolic disturbances in the spinal cord, including:

  • Impaired blood flow
  • Diminished oxidative metabolism
  • Metabolic failure at the mitochondrial respiratory chain level 3

Clinical Progression of Walking Difficulties

The gait disturbance typically follows a predictable pattern:

1. Early Stage: Subtle neurological changes with minimal gait abnormalities

   • May present as athletic slowness or difficulty keeping up with others 3
   • Patients may be "slow" athletically but otherwise functional 3

2. Intermediate Stage: Progressive difficulty with walking

   • Running becomes more difficult
   • Unsteady gait becomes more apparent 1
   • Leg pain may develop, especially with activity 3

3. Advanced Stage: Significant gait disturbance

   • Wide-based, unsteady gait
   • Spastic gait pattern
   • Significant weakness
   • Falls become common 1, 2

Risk Factors for Neurological Deterioration

• Residual Spinal Canal Diameter: Patients with cervical spinal canal diameter <10mm are at significantly higher risk for neurological deterioration even after minor trauma compared to those with canal diameter ≥10mm 4

• Minor Trauma: Even indirect minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal 4, 5

Diagnostic Evaluation

For patients presenting with gait disturbance potentially related to cervical stenosis:

• MRI of the cervical spine without IV contrast is the first-line imaging modality for evaluating both central canal and foraminal stenosis 1

• CT may be used if MRI is contraindicated or to better visualize bony structures 1

• Physical examination should focus on:

  • Testing peripheral reflexes (often hyperreflexic)
  • Assessing for sensory deficits in the lower extremities
  • Evaluating for Babinski sign (often positive)
  • Testing fine motor skills of the hands (often impaired) 5, 2

Clinical Implications and Management

The presence of gait disturbance in a patient with cervical stenosis represents a serious clinical concern requiring prompt evaluation:

• Prompt referral to a spine surgeon is recommended for any patient suspected of having cervical stenosis with myelopathy 2

• Surgical decompression is typically indicated for moderate to severe myelopathy with gait disturbance 2

• Delay in diagnosis and management can result in permanent disability and reduced quality of life 1

Coexisting Spinal Pathologies

It's important to note that some patients may have both cervical and lumbar stenosis:

• Patients with both conditions may present with mixed symptoms
• Cervical decompression often results in improvement of myelopathic symptoms but may not affect symptoms of neurogenic claudication from lumbar stenosis 6
• The order of surgical intervention should be based on the degree of myelopathy and radiculopathy 6

In summary, cervical stenosis is a significant cause of gait disturbance through spinal cord compression, and prompt diagnosis and management are essential to prevent permanent neurological deterioration and disability.