Surgery for cervical spinal cord compression in patients with multiple sclerosis

Area of Science:

• Neurology
• Neurosurgery
• Spinal Surgery

Background:

• Multiple sclerosis (MS) can cause myelopathy and bladder dysfunction.
• Neurological deterioration in MS patients may be exacerbated by coexisting cervical spinal cord compression from spondylosis or disc disease.
• Differentiating MS-related symptoms from spinal cord compression is clinically challenging due to overlapping presentations.

Purpose of the Study:

• To investigate the clinical and paraclinical features, treatment, and outcomes of patients with MS and concurrent cervical spinal cord compression.
• To identify factors that aid in distinguishing MS-related myelopathy from compression-induced myelopathy.
• To evaluate the efficacy and safety of surgical decompression in this patient cohort.

Main Methods:

• Retrospective review of medical records for patients with MS who underwent cervical decompression surgery.
• Data collection focused on pre- and postoperative clinical courses, symptoms, and outcomes.

Main Results:

• Thirteen of fourteen patients presented with progressive myelopathy, neck pain, or cervical radiculopathy.
• Bladder dysfunction was notably absent in this cohort of MS patients with moderate disabilities.
• Surgical decompression led to improvement or stabilization in most patients, with 21% maintaining improvement at a mean 3.8-year follow-up. No significant complications were reported.

Conclusions:

• Surgical decompression is a viable option for carefully selected MS patients with cervical spinal cord compression, offering potential benefits with low morbidity.
• Clinical indicators such as neck pain and cervical radiculopathy, alongside MRI findings, are crucial for accurate diagnosis and timely intervention.
• Prompt and accurate diagnosis can prevent delayed treatment and potentially improve patient outcomes.