Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: a cohort-controlled analysis.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.
Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave, Cleveland, OH 44195, USA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Daniel
D
Lubelski
Department of Neurological Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
Kalil G
KG
Abdullah
Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA.
Matthew D
MD
Alvin
Duke University, Durham, NC 27708, USA.
Timothy Y
TY
Wang
Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave, Cleveland, OH 44195, USA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Amy S
AS
Nowacki
Duke University, Durham, NC 27708, USA; Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, 10900 Euclid Ave, Cleveland, OH, USA.
Michael P
MP
Steinmetz
Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, 1950 E 89th St, Cleveland, OH 44106, USA.
Richard M
RM
Ransohoff
Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave, Cleveland, OH 44195, USA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Edward C
EC
Benzel
Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave, Cleveland, OH 44195, USA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA. Electronic address: mrozt@ccf.org.
Thomas E
TE
Mroz
D000328:Adult; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000601:surgery*; D015897:Comorbidity; D019299:Decompression, Surgical / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D019547:Neck Pain / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011843:Radiculopathy / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
Cervical stenosis; Multiple sclerosis; Myelopathy; Outcomes; Spinal cord compression; Surgery