Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults over 50 globally. It is caused by degenerative changes in the cervical spine -- disc bulging, osteophyte formation, and ligamentum flavum hypertrophy -- that progressively narrow the spinal canal and compress the spinal cord itself (not just the nerve roots). Spinal cord compression produces upper motor neuron signs rather than the lower motor neuron signs of nerve root compression.
How Cervical Myelopathy Affects Gait
The compressed cervical spinal cord carries the motor and sensory tracts that run between the brain and the lower body. Compression disrupts both:
- Upper motor neuron signs in the lower limbs: Spasticity (increased muscle tone), hyperreflexia, and clonus. The legs feel stiff and difficult to control rather than weak in the conventional sense
- Proprioceptive loss: The dorsal columns (carrying proprioceptive information from the lower limbs to the brain) are often compressed early. Loss of proprioception causes a characteristic unsteady gait that worsens when visual feedback is reduced (Romberg positive -- instability worsens when eyes closed)
- The myelopathic gait: Wide-based, unsteady, shuffling, with difficulty with rapid foot movements. Similar in some ways to Parkinson disease gait but without the freezing episodes and with different muscle tone characteristics
- Hand clumsiness: Myelopathy often presents with hand clumsiness (difficulty with fine motor tasks) before gait problems -- this affects cane grip
CSM Severity and Gait Impact
The Nurick scale classifies CSM gait involvement:
| Nurick Grade | Gait Description | Cane Role |
|---|---|---|
| 0 | No gait disturbance | Not required for CSM |
| 1 | Mild gait disturbance, fully employed | Prophylactic use in challenging environments |
| 2 | Gait disturbs activities but independently mobile | Regular use, all community ambulation |
| 3 | Requires walking aid or assistance | Essential; cane or bilateral aids |
| 4 | Requires assistance of another person | Cane insufficient alone; bilateral aids or wheelchair |
| 5 | Wheelchair dependent | Not applicable |
Surgical Treatment and Cane Use
CSM is typically treated surgically (anterior cervical discectomy and fusion, or posterior laminectomy) once gait is affected. Surgical decompression aims to arrest progression and can produce some recovery of function. Post-operatively, cane use continues during recovery and is weaned as neurological function returns. The pace of neurological recovery after CSM surgery is slow -- months to over a year -- and the cane should not be discontinued until gait assessment confirms it is no longer needed.
Grip in CSM
Myelopathy hand (intrinsic hand muscle weakness, clumsiness) affects grip. As with FRDA and other conditions where hand weakness is part of the clinical picture, a handle that requires less active grip force (Anatomic Grip) is preferable to one requiring precise sustained finger flexion.
View the DaiWalk cane range. Related: Walking Cane for Spinal Stenosis | Walking Cane for Spinal Cord Injury
