J Korean Soc Spine Surg.  2003 Mar;10(1):64-68. 10.4184/jkss.2003.10.1.64.

Disturbance of Toe Walking in Mid-lumbar Spinal Stenosis: Three Cases Report

• Song KJ
• Shin SJ
• Lee KR

• KMID: 2209706
• DOI: http://doi.org/10.4184/jkss.2003.10.1.64

Abstract

We report three cases of toe walking disturbance due to mid-lumbar spinal canal stenosis, which is a condition rarely reported in the literature. A severe bilateral S1 root lesion, associated with spinal stenosis at L3-4, is described. The diagnosis was obtained using computed tomography myelography (CTM) and magnetic resonance imaging (MRI). The findings at L5-S1 were minimal, and did not justify the patients clinical symptoms (disturbance of toe walking), but a detailed radiological evaluation revealed severe spinal stenosis at L3-4, which was assumed to be the cause of the S1 nerve root compression. A decompressive laminectomy, posterolateral fusion and posterior stabilization were performed. The pain and claudication had disappeared at the last follow-up evaluation, but the clinical symptom associated with the S1 root (toe walking) had not recovered.

Keyword

Mid-lumbar stenosis; Toe walking disturbance

MeSH Terms

Constriction, Pathologic
Diagnosis
Follow-Up Studies
Humans
Laminectomy
Magnetic Resonance Imaging
Myelography
Radiculopathy
Spinal Canal
Spinal Stenosis*
Toes*
Walking*

Figure

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  Fig. 1. Anteroposterior and lateral radiography demonstrating myelographic block at L3-4 and L4-5 level.

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  Fig. 2. An axial image of the L3-4 myelo-CT shows central and foraminal stenosis with hypertrophied facet joint, ligamentum flava and its disc extrusion.

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  Fig. 3. A T2-weighted sagittal image showing degenerated discs with canal stenosis at L3-4 and L4-5.

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  Fig. 4. An axial image of the MRI show stenosis of central portion of spinal canal by hypertrophied facet joint, ligamentum flava and extruded disc at L3-4 level.

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  Fig. 5. Solid union with stable posterior stabilization were achieved using plain radiography, and neurogenic claudication improved but toe gait disturbance was persist-ed on 24 months follow-up evaluation.

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