Compressive Cervical Myelopathy in Patients With Demyelinating Disease of the Central Nervous System: Improvement After Surgery Despite a Late Diagnosis

Abstract

Objective We aimed to assess the impact of surgical intervention on outcome in patients diagnosed with demyelinating disorders and cervical degenerative disease warranting surgical intervention. Methods The records of patients with a diagnosis of a demyelinating disorder of the central nervous system who underwent cervical spine surgery at a single institution from 2016 to 2020 were reviewed. Demyelinating disease included multiple sclerosis (MS), neuromyelitis optica, and transverse myelitis (TM). The dates of initial spine symptom onset, recognition of spinal pathology by the primary provider, referral to spine surgery, and spine surgery procedures were collected. Hospital length of stay (LOS) and postoperative outcomes and complications were recorded. Results A total of 19 patients with a diagnosis of demyelinating disorders underwent cervical spine surgery at our institution. Seventeen patients had MS. The average time interval between a documented diagnosis of myelopathy or radiculopathy and referral to the Spine clinic was 67.95 months (M=40, SD=64.87). Twelve patients had imaging studies depicting degenerative spine disease that would warrant surgical intervention at the time of examination by their primary physician. The average delay for referral to the Spine clinic for these patients was 16.5 months (M=5; SD=25.36). More than 89% of patients experienced significant neurologic improvement postoperatively. Conclusions There is a delay in the recognition of cervical spine disease amenable to a surgical resolution in patients with demyelinating disorders. Surgical treatment can lead to significant clinical improvement in this patient population even if delayed, and likely carries similar risk to that of the general population.

Cost-effectiveness analysis of rituximab versus natalizumab in patients with relapsing remitting multiple sclerosis

“…The average life expectancy of the patients is 40 years from the onset of the disease, which is 5 to 10 years less than the average life expectancy of non-infected people. About 60% of MS patients reach the age of 70 [ 15 ]. Furthermore, studying the patients with reduced disability Disease-modifying therapies (DMT) showed that about 90% of the total cost of the patients with mild to moderate disability was associated to drugs, and it was found out that the costs of drugs (except DMT) and non-medical sources were higher for the patients with a more severe disease.…”

Differentiating Neurodegenerative Disease from Compressive Cervical Myelopathy Using Motor Evoked Potentials

“…30,31 However, unlike ALS, surgery might be acceptable in patients with MS, as patients with combined CCM and MS have reportedly shown improvement in symptoms with surgery. 7,32,33 We acknowledge several limitations. There were significant age differences among the groups, which may have been partly due to differences in the preferred age of onset of each disease and partly due to the younger age range of the controls.…”

“…There might be no obvious difference between CCM and DDC as axonal abnormalities in the corticospinal tract are associated with abnormal MEPs in both CCM and DDC, and the pathophysiology of CCM includes demyelination 30,31 . However, unlike ALS, surgery might be acceptable in patients with MS, as patients with combined CCM and MS have reportedly shown improvement in symptoms with surgery 7,32,33 …”

Neuromyelitis Optica Spectrum Disorders (NMOSDs) Diagnosed After Surgery for the Ossification of the Posterior Longitudinal Ligament of the Cervical and Thoracic Spine: A Case Report

“…Many of these symptoms are also common in patients with cervical spondylotic myelopathy (CSM). The coincidence of CSM with demyelinating disorders has been reported in the past, and diagnosis and treatment tend to be delayed in such cases [ 10 ].…”