title: Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis?
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 52.7 years (range 40-72 years). 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.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W Harrison Street, Suite 855, Chicago, IL 60612, USA. Electronic address: manish_kasliwal@rush.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Kasliwal
authors.affiliation: Department of Neurology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Muth
authors.affiliation: Department of Neurology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Dusan
authors.initials: D
authors.lastname: Stefoski
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, 1725 W Harrison Street, Suite 855, Chicago, IL 60612, USA.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Traynelis
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion; D016896:Treatment Outcome
keywords: Cervical spondylosis; Multiple sclerosis; Myelopathy; Neck pain; Radiculopathy; Urinary dysfunction