Surgery for Cervical Spinal Cord Compression in Patients with Multiple Sclerosis

Cai, Christopher Y.; Moore, Thomas A.; Whitaker, John N.; Hadley, Mark N.

doi:10.1227/00006123-200009000-00022

Cited by 3 publications

(5 citation statements)

References 22 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

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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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“…14 The most common symptoms found during a retrospective study of 14 people with definite MS who were scheduled for cervical decompression surgery were progressive myelopathy and radiculopathy. 15 Important clinical considerations for cervical disease include the following: the age of the patient, a history of falls or trauma, repetitive activities, deconditioning, and comorbid diseases such as osteoporosis and diabetes that place the patient at risk. 16 Correctly identifying spinal abnormalities will determine effective strategies, physical therapy interventions, goals, and optimal outcome for rehabilitation.…”

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confidence: 99%

Cervical Disk Pathology in Patients With Multiple Sclerosis: Two Case Reports

2012

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“…The authors explained that their findings were consistent with those of Lubelski et al [13] in that most patients with myelopathy achieved only stability in symptoms (62%) rather than improvement (30%). These results, together with those of Young et al [10], Arnold et al [11], Burgerman et al [12], Lubelski et al [13], and Bashir et al [14] reported above, suggest that surgical treatment may be indicated for relief of neck pain and radicular symptoms rather than the myelopathic symptoms that will progress with MS. Moreover, the collective evidence suggests that surgery does not result in exacerbations of MS.…”

Section: Resultsmentioning

confidence: 51%

“…Bashir et al [14] published a case series that found similar outcomes in patients with MS and coexisting spinal cord compression due to cervical spondylosis or cervical disc disease. Fourteen patients underwent cervical decompression surgery to address presenting symptoms of neck pain ( n = 11), cervical radiculopathy ( n = 10), and progressive myelopathy ( n = 13) (mean follow-up, 3.8 years; range, 1.0–9.8 years).…”

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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Surgery for Cervical Spinal Cord Compression in Patients with Multiple Sclerosis

Cited by 3 publications

References 22 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

Cervical Disk Pathology in Patients With Multiple Sclerosis: Two Case Reports

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

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