Unsuspected multiple sclerosis in patients with presumed chronic spondylotic myelopathy: report on 4 cases

Differential diagnosis between spondylotic cervical myelopathy and multiple sclerosis or other neurologic conditions may occasionally be difficult. Problems establishing the correct diagnosis are mentioned, topical literature is discussed and four criteria to establish the diagnosis of compression myelopathy are presented. We conclude that demyelinating diseases should be excluded prior to surgical management of cervical compression myelopathy because surgical intervention can result in marked worsening of symptoms.