Article

Clinical Outcomes Following Surgical Management of Coexistent Cervical Stenosis and Multiple Sclerosis: A Cohort Controlled Analysis.

Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, USA
The spine journal: official journal of the North American Spine Society (Impact Factor: 2.8). 11/2013; 14(2). DOI: 10.1016/j.spinee.2013.11.012
Source: PubMed

ABSTRACT The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment, due to the similarities of presentation and disease progression. There are only a few published case-series that examine this unique patient population.
1) To define the demographic features and presenting symptoms of patients with both MS and CS, and 2) To investigate the immediate and long-term outcomes of surgery in patients with MS and CS.
Matched cohort controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and mJOA scores were collected as well.
Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy, and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year.
154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78% versus 47%; p=0.0001) and preoperative radiculopathy (90% versus 75%; p=0.03) than their counterparts in the MS group. Patients in the MS group had a significantly lower rate of postoperative resolution of myelopathic symptoms in both the short-term (39% in the MS group did not improve versus 23% in the control group; p=0.04) and the long-term (44% in the MS group did not improve versus 19% in the control group; p=0.004). Preoperative myelopathy scores were worse for the MS cohort as compared to the control cohort (1.8 versus 1.2 in the Nurick scale, p<0.0001; 13.7 versus 15.0 in the mJOA scale, p=0.002). This difference in scores became even greater at the last follow up visit with Nurick scores of 2.4 versus 0.9 (p<0.0001) and mJOA scores of 16.3 versus 12.4 (p<0.0001) for the MS and control patients, respectively.
Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that 1) myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily due to progression of MS, and 2) that surgery can help alleviate neck pain and radicular symptoms.

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    ABSTRACT: Cervical stenosis (CS) and multiple sclerosis (MS) are two common conditions with distinctive pathophysiology but overlapping clinical manifestations. The uncertainty involved in attributing worsening symptoms to CS in patients with MS due to extremely high prevalence of asymptomatic radiological CS makes treatment decisions challenging. A retrospective review was performed analyzing the medical records of all patients with confirmed diagnosis of MS who had coexistent CS and underwent surgery for cervical radiculopathy/myeloradiculopathy. Eighteen patients with coexistent CS and MS who had undergone cervical spine decompression and fusion were identified. There were six men and 12 women with an average age of 52.7years (range 40-72years). Pre-operative symptoms included progressive myelopathy (14 patients), neck pain (seven patients), radiculopathy (five patients), and bladder dysfunction (seven patients). Thirteen of the 14 patients (92.9%) with myelopathy showed either improvement (4/14, 28.6%) or stabilization (9/14, 64.3%) in their symptoms with neck pain and radiculopathy improving in 100% and 80% of patients, respectively. None of the seven patients with urinary dysfunction had improvement in urinary symptoms after surgery. To conclude, cervical spine decompression and fusion can improve or stabilize myelopathy, and significantly relieve neck pain and radiculopathy in the majority of patients with coexistent CS and MS. Urinary dysfunctions appear unlikely to improve after surgery. The low rate of surgical complications in our cohort demonstrates that cervical spine surgery can be safely performed in carefully selected patients with concomitant CS and MS with a good clinical outcome and also eliminate CS as a confounding factor in the long-term management of MS patients.
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