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