Abstract
Background context
The presentation of myelopathy in patients with the concomitant diagnosis of cervical
stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment
because of the similarities of presentation and disease progression. There are only
a few published case series that examine this unique patient population.
Purpose
To define the demographic features and presenting symptoms of patients with both MS
and CS and to investigate the immediate and long-term outcomes of surgery in patients
with MS and CS.
Study design/setting
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 modified Japanese Orthopaedic Association scores were collected as well.
Methods
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.
Results
A total of 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% vs. 47%; p=.0001)
and preoperative radiculopathy (90% vs. 75%; p=.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 vs. 23% in the control group; p=.04) and the long-term (44% in the MS
group did not improve vs. 19% in the control group; p=.004). Preoperative myelopathy
scores were worse for the MS cohort as compared with the control cohort (1.8 vs. 1.2
in the Nurick scale, p<.0001; 13.7 vs. 15.0 in the modified Japanese Orthopaedic Association
scale, p=.002). This difference in scores became even greater at the last follow-up
visit with Nurick scores of 2.4 versus 0.9 (p<.0001) and modified Japanese Orthopaedic
Association scores of 16.3 versus 12.4 (p<.0001) for the MS and control patients,
respectively.
Conclusions
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 myelopathy symptoms
are less likely to be alleviated completely or may only be alleviated temporarily
because of progression of MS and that surgery can help alleviate neck pain and radicular
symptoms.
Keywords
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Article info
Publication history
Published online: November 14, 2013
Accepted:
November 8,
2013
Received in revised form:
August 29,
2013
Received:
January 12,
2013
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: DL: Nothing to disclose. KGA: Nothing to disclose. MDA: Nothing to disclose. TYW: Nothing to disclose. ASN: Nothing to disclose. MPS: Royalties: Biomet Spine (None); Consulting: Biomet Spine (A). RMR: Nothing to disclose. ECB: Royalties: Elsevier Pub (B), Thieme Pub (B); Stock Ownership: Axiomed (E), Depuy (None), Orthomems (E), Turning Point (B); Consulting: Axiomed (B); Grants: OREF (F, Paid directly to institution), Rawling (F, Paid directly to institution); Other: Inventor of technology that is assigned to Cleveland Clinic and licensed to Axiomed and Orthomems (None). TEM: Stock Ownership: PearlDiver Inc (None); Consulting: Globus Medical (B); Speaking and/or Teaching Arrangements: AO Spine (B).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
No grants or technical or corporate support were received in conducting this study or writing this manuscript. Institutional review board approval (Study #11-285) was obtained before the start of the study.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
