Thoracic spinal cord lesions are influenced by the degree of cervical spine involvement in multiple sclerosis

Abstract

Study design: Cross-sectional analyses. Objective: To determine whether cervical spinal cord lesions predict the presence of thoracic cord lesions in multiple sclerosis (MS) patients. Setting: Single MS Clinic, AZ, USA. Methods: All MS patients, with MRI studies of the brain, cervical and thoracic spine obtained during a single scanning session, were acquired during a 1-year period. Clinical, demographic and imaging covariates were used in a multivariate regression model to refine predictors of thoracic cord involvement. Results: A total of 687 patients were evaluated, and patients were excluded because of a diagnosis of other neurological disorders, not meeting the 2010 McDonald criteria for MS (n = 222) or incomplete neuraxis imaging (n = 339). The study cohort comprised 126 patients. There was an increase in the odds ratio (OR) of thoracic spine involvement when any cervical spine lesion was present (OR = 6.08, 95% confidence interval (2.21-16.68), Po0.001). The multivariate logistic regression model demonstrated a substantial and significant increase in the odds of thoracic spine involvement when more than two cervical spine lesions were present, two lesions (OR 4.44, (0.91-21.60), P = 0.06), three lesions (OR 19.76,, P = 0.001), four or more lesions (OR 20.49,), P = 0.012) and diffuse lesions (OR 71.94,), P = 0.001), when adjusting for significant covariates including clinical symptoms, brain lesions, disease duration and treatment exposure. Conclusions: Thoracic spinal cord lesions appear to be predicated on the degree of cervical spine involvement in patients with MS, a risk that appears to be independent of brain findings or clinical features.

Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis

“…There are scant published data about craniocaudal location of myelitis and pain. We suggest that one reason NMOSD TM sufferers experience more pain than MS patients might relate to the differing proportions of cervical and thoracic cord involvement in the two conditions 4. In support of this hypothesis, Okuda et al 5 have reported that pain in MS associates with upper/mid-thoracic damage and propose an autonomic aetiology.…”

“…Known differences in NMOSD and MS cord lesions potentially provide insights into this disparity and the observation that MS lesions predominantly involve the cervical cord, whereas NMOSD lesions are frequently thoracic4 might be a contributor, particularly as a recent paper implicated thoracic cord lesions in the aetiology of MS chronic pain 5…”

A Novel Cervical Spinal Cord Window Preparation Allows for Two-Photon Imaging of T-Cell Interactions with the Cervical Spinal Cord Microvasculature during Experimental Autoimmune Encephalomyelitis

“…Importantly, magnetic resonance imaging (MRI) of the spinal cord in MS patients demonstrated a higher frequency of cervical spinal cord lesions than thoracic or lumbar spinal cord lesions (32, 33). Recent advanced MRI imaging has pointed to a predominance of lesions in the cervical spinal cord of MS patients probably due to the fact that the cervical spinal cord has a greater cross-sectional area and contains more myelin per spinal segment than lower segments of the spinal cord (34). This study highlighted the importance of including imaging of different segments of the spinal cord in MS patients to improve understanding of disease progression and to facilitate treatment choices (34).…”

“…Recent advanced MRI imaging has pointed to a predominance of lesions in the cervical spinal cord of MS patients probably due to the fact that the cervical spinal cord has a greater cross-sectional area and contains more myelin per spinal segment than lower segments of the spinal cord (34). This study highlighted the importance of including imaging of different segments of the spinal cord in MS patients to improve understanding of disease progression and to facilitate treatment choices (34). Neuroanatomical differences of the cervical versus thoracic or lumbar spinal cord may extend to differences in angioarchitecture and thus hemodynamic parameters, which will finally impact on immune cell trafficking to the different segments of the spinal cord.…”

Spinal cord atrophy in anterior-posterior direction reflects impairment in multiple sclerosis

“…Magnetic resonance imaging (MRI) of the brain and spinal cord is the method of choice for in vivo assessment of MS‐related brain and spinal cord pathology . However, lesion location and load within the CNS correlate poorly with clinical disability and have limited prognostic value …”