Impact of cervical stenosis on multiple sclerosis lesion distribution in the spinal cord

Abstract

To determine whether demyelinating lesions attributable to multiple sclerosis (MS) occur more commonly in regions of pre-existing cervical stenosis (CS).Design/Methods: One hundred comorbid MS/CS patients and 100 MS-only controls were identified via ICD codes and radiology reports from a retrospective chart review of the records of the University of Pennsylvania Hospital System (UPHS) from January 1 st , 2009 to December 31 st , 2018. For each patient, axial and sagittal T2 sequences of cervical MRI scans were examined. The cervical cord was split into 7 equal segments comprising the disc space and half of each adjacent vertebral body. Each segment was assessed for the presence of MS lesions and grade 2 CS or higher by previously published criteria. Lesions which were concerning for spondylotic-related signal change based on imaging characteristics were excluded (n=6, 3.2%). Clinical data was extracted from the electronic medical record.Results: Average age at the time of MRI was 57.0 +/-10.5 years and average time with MS diagnosis was 15.3 +/-9.2 years. The majority of patients had a diagnosis of relapse-remitting MS (81.0%) and the F:M ratio was 3.5. Eighty-five percent of patients were on treatment at the time of MRI, most often glatiramer acetate (35.0%). Spinal segments with at least grade 2 stenosis were significantly associated with the presence of an MS lesion in the same segment (χ 2 = 19.0, p < 0.001, OR = 2.6, 95% CI 1.8-3.7).Conclusions: Our data suggest there is a significant association between segments of spinal cord with at least moderate CS and segments with MS lesions. Further analysis is required to assess if cervical stenosis is a causative or aggravating factor in multiple sclerosis.

Association between cervical disc disease and lesions of multiple sclerosis

“…A recently published study also suggested an association between MS lesions and at least moderate cervical stenosis. 11 However, our study did not find any association between cervical discopathy and MS lesions in the corresponding cervical segment. The discordance between the results of the studies could be attributed to differences in genetic and environmental factors between study populations.…”

“…10 A more recent study suggested a similar association between MS lesions and at least moderate cervical stenosis. 11 In our study, we reviewed the clinical data and magnetic resonance imaging (MRI) scans of MS patients with discopathy seen at our MS clinic in 2018, and examined the possible association between them.…”

Cervical spinal degenerative disease in multiple sclerosis

“…At autopsy, Brain and Wilkinson [24] had noted that cord demyelination was most extensive at compression sites. Lesions typical of MS were more likely to occur at levels of existing cervical spondylosis, versus levels without, in PwMS [36]. The pathophysiological basis for such an interaction could include bystander activation of local inflammatory responses in either cord parenchyma or surrounding musculoskeletal structures, as well as compressive ischaemia of the cord.…”

“…in PwMS [36]. The pathophysiological basis for such an interaction could include bystander activation of local inflammatory responses in either cord parenchyma or surrounding musculoskeletal structures, as well as compressive ischaemia of the cord.…”

Spinal Cord Sarcoidosis Occurring at Sites of Spondylotic Stenosis, Mimicking Spondylotic Myelopathy: A Case Series and Review of the Literature

“…Regarding intramedullary spinal neurosarcoidosis occurring as isolated CNS involvement only at sites of spinal canal stenosis, it has long been postulated that other inflammatory lesions, specifically MS plaques, tend to occur at sites of cord trauma and degenerative stenosis, with close anatomic correspondence between mechanical stresses on the cord by spondylosis and spinal cord MS plaques. 22,23 The trauma could result in loss of blood-cord barrier impermeability, which could allow the entrance of the antigen responsible for sarcoidosis into the cord as well as the entrance of T lymphocytes to set off the inflammatory cascade. As stated by Hickey, 24 "any mechanism that physically destroys the components of the blood cord barrier will render the CNS open to the cellular and molecular constituents of the blood.…”