Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis?

Tan, Lee A.; Kasliwal, Manish K.; Muth, Christopher C.; Stefoski, Dusan; Traynelis, Vincent C.

doi:10.1016/j.jocn.2014.05.023

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…Presenting symptoms of severe CS and spinal cord MS overlap significantly and can include gait dysfunction, ataxia, extremity weakness, sensory disturbances, and bowel and bladder dysfunction. Because of these similarities, determining the contribution of each disorder to the clinical features of cervical myelopathy can prove to be quite challenging (Young et al, 1999;Bashir et al, 2000;Bashir et al, 2001;Tan et al, 2014;Lubelski et al, 2015;Xydis et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…To date, no large cohort study or randomized trial has been performed to further characterize the relationship between MS and CS. However, many authors have addressed whether cervical decompression surgery is beneficial for patients with both co-morbidities (Young et al, 1999;Bashir et al, 2000;Bashir et al, 2001;Tan et al, 2014;Lubelski et al, 2015;Purvis et al, 2017;Vedantam and Rajshekhar, 2013). Only retrospective data exist to answer this question, and their findings are mixed.…”

Section: Introductionmentioning

confidence: 99%

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

Gratch

Khankhanian

et al. 2020

Multiple Sclerosis and Related Disorders

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gratch

Khankhanian

et al. 2020

Multiple Sclerosis and Related Disorders

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“…One study by Tan and colleagues [15] did show a reduction in myelopathy in addition to an improvement in radicular symptoms and neck pain. Eighteen patients with concurrent MS and CSM were identified after undergoing cervical spine decompression and fusion (mean follow-up, 18 months; range, 3–45 months).…”

Section: Resultsmentioning

confidence: 99%

Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson’s Disease?

2017

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A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the current literature on the appropriate surgical management of patients with concurrent multiple sclerosis (MS) and cervical spondylotic myelopathy (CSM), and those with both Parkinson’s disease (PD) and CSM. MS and CSM patients may benefit from surgery to reduce pain and radiculopathy. Surgical management in PD and CSM patients has shown minimal quality-of-life improvement. Future studies are needed to better characterize demyelinating disease patients with concurrent disease and to determine ideal medical or surgical treatment.

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“…Our data adds to this body of literature by showcasing that the benefit from surgery persists despite long delays. While nonsurgical management with external cervical immobilization has been recommended in the past for managing patients with coexistent MS and CS [9], more recent analyses have advocated for the safety and effectiveness of surgical decompression [6,7,10,11]. This paradigm shift likely reflects recent advances in the medical management of demyelinating disorders which minimizes postoperative flares of the disease, and also highlights the tremendous improvement in safety and efficacy of spinal instrumentation over the past 20 years.…”

Section: Discussionmentioning

confidence: 99%

“…The coincidence of cervical spondylosis (CS) causing neural element compression and demyelinating disorders (DD) can blur the clinical picture and make surgical decision-making difficult. Prior studies have demonstrated that patients with DD and CS may benefit from surgical decompression [3][4][5][6][7]. However, it is still unclear how this combination delays the appropriate diagnosis and treatment of surgical spine disease, and whether surgical treatment can still clinically benefit patients despite this delay.…”

Section: Introductionmentioning

confidence: 99%

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

Youssef¹,

Barrie²,

Elguindy³

et al. 2021

Cureus

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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.

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Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis?

Cited by 8 publications

References 17 publications

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

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

Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson’s Disease?

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

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