The Fall, Camden Koko, London

Still crazy after all these years

In recent years, Smith has stopped touring Britain in any conventional sense, instead booking backwater working-men's clubs for one-off shows earthier and more interesting than the usual bourgeois rock grind. North London indie haunt Koko is rammed with the faithful and curious anyway. They are rewarded with a Smith who has compensated for his incapacity with unusually emphatic, dextrous vocals, letting those snarling lyrics leap at us. Even the most harmless phrases drip with intent. "My door is always open – for you-ou, babe!" he sings on "My Door Is Never" in an insultingly distant, slurred croon.

In exactly the same way as his American (and only) equivalent, Pere Ubu's David Thomas, that sound is Smith having to find avant-garde, intractable-sounding ways to arrive at the effect primal rock'n'roll had when he first heard it. Tonight's bludgeoning bass and drums and guitar fuzz and twang draw massively on 1950s hard-rock pioneer Link Wray. The suggestion is this is all basic stuff: an old language that we've forgotten.

For "50 Year Old Man" (part of a set typically weighted to The Fall's latest, 27th studio album Imperial Wax Solvent), Smith spins himself threateningly towards the drummer, seemingly intent on mischief. But he is too tired. The song is a busted multi-part epic, about old-fashioned, pub snug-room middle-aged decrepitude. The lank-haired, 52-year-old Smith, trying out an emphysemic, wheezing high voice while confined to a wheelchair, sees more dignity in such a state than modern middle-age's ersatz youth. His very presence tonight seems to test the limits of how battered and socially suspect you can be, and still take the stage to play rock'n'roll.

Huddled in the shadows, poring over a roll of lyrics, Smith spits: "What d'you want? D'you want anything any more?" It's a challenge to the needy passivity of the generations who have inherited Brando's mumbled, easy "Whaddaya got?" idea of rebellion. As he roams round the back of the stage, his wife and keyboard player Elena Poulou sings the disdainful "I've Been Duped". She has an old-school punk yelp, like X-Ray Spex's Poly Styrene. The affecting lyrics about suffering First World War soldiers and other indignities beamed in as Smith simmers watching TV, is summarised: "My TV/ Always in front of me."

Smith stands up briefly during "Latch Key Kid", to rousing cheers. Finally, during "Reformation!", he simply disappears. He keeps singing, perhaps toying with technology letting him actually phone a gig in. The Fall wander off, too, after a while, and when they return for an encore, he doesn't. They play more smashed, ominous rock. As the mic-stand is passed into the crowd, the last words could come from Smith, a fan, or a ghost: "I hear you, telephone bills, listening in." Paranoid, absurd, brilliant, and the sound of a man in a tenement who will never trust the council: Mark E Smith in excelsis.