The Surgical Walk

The key to treating a patient who has a walking problem is to observe their gait carefully and diagnose them accurately

“You’ve got a compression in your thoracic spine,” I proclaimed, as I saw 68-year-old Mr. Shaikh shuffle towards the door of my consulting room that I was holding ajar for him. He wore a white kurta and adorned a long stringy silvery beard to go with it. I usually refrain from making any diagnosis until I listen to a patient’s complete history and perform a detailed examination, but his short stiff steps that seemed a little out of his own control gave it away. His wife held one arm while I firmly gripped the other, as we gently helped him into his chair and allowed him to tell me why he was here.

‘I’ve been diagnosed with Parkinson’s,” Mr. Shaikh said. “I’ve been taking medication for a while but its only getting worse. I was feeling better than James Bond just a few years ago,” he lamented, remembering an earlier, healthier time. He appeared fidgety with his hands, which was probably assumed to be a tremor by his treating doctor. Patients with Parkinson’s have an extremely stoic looking face, often deadpan, and they blink very little, but he seemed pretty animated in expressing his difficulty in walking. “Do you wake up in the middle of the night and shout sometimes?” I asked; some patients with Parkinson’s have a sleep behavioural disorder. “She does that!” he jested, pointing to his wife. “That’s because he gets up and turns the light on every few hours to pass urine,” she said giving me another clue in the puzzle.

I examined him to find his upper limbs devoid of the usual rigidity that we expect in Parkinson’s, but his legs were stiff as logs. While he sat on the examining bed facing me, I tapped on his knees with a neurological hammer and his feet briskly sprung up in the air and back. If you are positioned directedly in front of a patient while doing this, you can injure vital parts of your anatomy, but with experience, you learn where to stand. However, as I remember reading somewhere, experience is something I’d like to have without going through all the trouble of getting it.

“Sometimes, progressive degenerative conditions of the brain and spine have several mimics,” I finally asserted, and to confirm my suspicion, continued with, “It would be best to get an MRI of the spine.”

He returned within a few weeks, this time taking a little longer to position himself than he did the last time he was here.“You’re right, doctor, the report does mention severe compression,” he said, while his wife handed over the MRI films to me. I slid the scan into the groove of the light box and showed them where the ligament over the fourth and fifth thoracic vertebrae had thickened, thinning the spinal cord considerably. This MRI visual is one that most patients seem to intuitively understand, instantly relating it to being responsible for their symptoms. “This will need an operation, Mr. Shaikh. We’ll position you on your belly, make an incision over the upper part of your back, drill off the bone, and bite off the thickened ligament, giving the spinal cord its rightful space. Over the next few months, your gait will improve dramatically,” I said confidently. “Will I go back to being James Bond?” he wondered aloud. “Shaikhen but not stirred,” I punned, but he didn’t smile. I’ll admit it wasn’t a very good joke.

We operated on him a few days later. We cut down from skin to bone, cleanly dissecting the muscle off it. I then drilled a trough on either side of the bone and lifted the back of the vertebra in a single piece. We nibbled all over the thickened ligament as the compressed covering of the spinal cord finally came to the surface, one bite at a time, assuming its normal rounded position, free and breathing easy. “I already feel less tight in my legs,” he muttered in his partly conscious state, as we wheeled him out of the operating room. A few months later, when he came in to see me, he looked several years younger. His walk was swift and smooth, with perfect cadence and in complete control. “Do you feel like James Bond now,” I asked, after seeing him so relieved and happy. “I just bought an Aston Martin!” he quipped.

In any patient who has a problem walking, diagnosing it rightly is the key to successfully treating it. I remember, as a child, standing with my dad on the balcony of our home and identifying gait disorders. We have a garden in front of our house, and as the number one advice given by any doctor to someone who has a walking problem is that the patient should take a walk, we were treated to a spectrum of ailments we had fun identifying. Sometimes, when I disagreed with my dad, I would run down to ask the person walking if what he had was indeed what my father said he did, and was amazed by his clinical acumen when we got an affirmative answer. There was someone who would walk a few quick steps, then freeze, and then repeat the pattern. “That’s the propulsive gait of Parkinson’s,” my dad taught me when I was eight. Then, there was someone who would swerve his leg out with every step. “This guy has had a stroke and residual hemiparesis,” I learnt.

People who have an excess accumulation of fluid within the ventricles tend to walk with a broad-based gait, as if their feet were refusing to leave the ground. The gait is referred to as magnetic and is seen in patients with a condition called normal pressure hydrocephalus. Patients who have a foot drop slap their foot on the ground making a distinct sound;often, just hearing (not seeing) a patient walk can establish the diagnosis. A painful or an antalgic motion could either be because of arthritis of the knee or hip or spinal stenosis, and oftentimes patients can have both; my orthopaedic colleague and I have constantly discussed the overlap. Children with cerebral palsy have a scissoring gait where their feet crisscross while walking.

After thus learning about different kinds of gaits as a medical student, I once took profound responsibility for the knowledge I had and went up to someone in the garden across my house. I told them they walked this way because they had a slipped disc and needed to be urgently evaluated. “I’m sorry, young man,” the elderly gentleman kindly told me, putting his best foot forward, “it’s just a shoe bite from an ill-fitting shoe I’m dealing with!”

20 Comments on “The Surgical Walk
  • Bikram Dr. Shakya says:

    Yes, it’s Gait that can give u diagnosis instantly !!!
    Good reading…

  • Chanda says:

    Good morning! And….what a beautiful morning it is..after reading this article. I stupidly still have the grin. Every Para has a quip. The alternate Sundays are just not complete without your writeups. Please don’t think of stopping at any time Doc else, Sundays wouldn’t be pleasant. What more can be said….

  • Supriya Correa says:

    Clues and more clues. You sound like Hercule Poirot. Nice post though.

  • Arun Pushkarna says:

    Superb Mazda. Breaking from the tradition of saving your humour for the last word, this time you have liberally interspersed the article with opportunities to chuckle.
    As usual, you educate while you entertain.

  • Dorothy says:

    No wonder you are so experienced Doc.
    You started early with the lessons from your dad.
    We thank him

  • Anuradha says:

    A very interesting and entertaining article! Informative as well and laced with your unique sense of humour. Love reading your articles

  • Chandan R. Sanjana says:

    So true, a greatly experienced Neuro Surgeon can figure out what is wrong with a patient by just looking at the way the patient walks. So great that this gentleman got back his proper gait and walked like James Bond.loved the line about the slipped disc and the ‘shoe bite’. The later can be a very painful condition.
    Another great article Mazda.

  • Rekha G Melwani says:

    An interesting and informative article .. An eye opener.. love the subtle sense of humour too .

  • Avinash Karnik says:

    Dear Mazda,
    As normally is, this article also made me eager to finish it one shot. You have an expertise in spotting the gaps in the spine and you use the same experience while filling some gaps in your article with humour. What an art!
    Congratulations and all the very best as a neurosurgeon and also as a writer

  • Marzian Mowji says:

    The real James Bond would be lucky to have you as his doctor, considering all the stunts he does.
    It was interesting to learn that even a person’s gait can give clues as to what ails him/her.
    I am well into my 60s, and with that comes all the aches and pains of wear and tear. Someday I might have to consult a doctor and I hope you are still practicing then.

  • Burzin Panthaki says:

    Thank you Dr Mazda for a very informative and entertaining article with the right dash of humour.

  • Vipul Shah says:

    Dearest Doctor Mazda

    U R my James Bond ….

    What a wonderful way of seeing & evaluating

  • Rita singh says:

    Dear doctor,thank you so much for ur fascinating medical writings.Just by reading ur articles we have come to b aware of so many medical issues. Thank for educating and entertaining free of cost.

  • Zee Pasta says:

    There once was a neurosurgeon Mazda named

    Who pontificated on gaits, maimed, untamed

    With no verbal paralysis

    He utters spot on analyses

    We trust our bond

    With our Dr Gems Bond

    Stirs our respect deeper ever

    And our faith in him.. Shaken never!


    Kudos Dr Mazda for yet another Greatread!

    Reminded me of my friend’s mother whose changed gait was never analysed to reveal something more sinister. .MSA
    Her fate was worse than your James Bond..

    The gait game with your dad when you were sooooo little reminded me of a great mum n dad.. both eye docs..
    Who would push in video tapes for their lil daughters to feast their optic orbs on..
    Not cartoons.. But eye surgeries..
    The older girl still remembers them.. A fine ophthalmic surgeon in her own right today !

    Loved your humour laced greatread as usual..
    What a wondrously well mixed cocktail you concoct!
    The James Bond theme brought on the smileys..

    But your Shaikhen not stirred brought on a maha guffaw.. 🤪😃🤣

    You’re wrong.. Twas no bad joke..
    No koilu per eedu 🐣

    I have a friend whose gait over the past months has visibly changed.. I do hope she makes her way to you..

    Not in an Aston Martin.. Kaali peeli will have to do..

    Now *THAT* was koilu per eedu 😖

    With much love light gratitude n hugs alwayssss.. And beyond… ❤️

  • Homi R. Cooper says:

    Thank u for Sharing Good Knowledge.
    Sharing is Caring.
    Great Job.

  • Anita says:

    Humourous read and so true from such a brilliant doctor

  • Dr Shivkumar V Dalvi says:

    Excellent detectivegiri by Dr Mazda.Grt he had super detective Dad to guide him during his early yrs.Very practical n interesting article , much appreciated.Thanq

  • Bapsy Bengali says:

    Dr Mazda articles are always very interesting n informative..always looking forward to read them…may God always bless u..

  • Cara Lalwani says:

    Dr Mazda….God bless
    primum non nocere

  • Di says:

    As always well written… doctor in the making at 8 years old… how lovely to read about ur dad and u guessing gait disorders.. great knowledge and expertise passed down from father to son… lol hahaha loved the end of the article


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