Cervical spinal degenerative disease in multiple sclerosis.

Simran Chhugani,Florina Borca,Nivedita Agarwal,Ian Galea,Faraz Sheikh,Aginor Spanoulis

doi:10.1111/ene.14855

Abstract

Root and cord irritation from cervical spinal degenerative disease (SDD) may share clinical features with progressive multiple sclerosis (MS), so diagnostic overshadowing may occur. We hypothesized that cervical stenotic SDD is commoner in people with progressive MS, compared to controls. A retrospective case-control study of 111 cases (56 with progressive MS and 55 age- and sex-matched controls) was conducted. Five types of cervical SDD (disc degeneration, posterior disc protrusion, endplate changes, canal stenosis and foraminal stenosis) were assessed objectively on magnetic resonance imaging using published scales. Multivariable regression analysis was performed. Moderate-to-severe cervical spinal degeneration occurred more frequently in progressive MS, compared to controls. In multivariable regression, foraminal stenosis was three times more likely in progressive MS (odds ratio3.20, 95% confidence interval 1.27, 8.09; p=0.014), and was more severe (p=0.009). This finding was confirmed on retrospective evaluation of clinical radiology reports in the same population. Foraminal stenosis was twice as likely in progressive MS, compared to relapsing-remitting MS. People with progressive MS are susceptible to foraminal stenosis. A higher index of suspicion for cervical SDD is required when appropriate neurological symptoms occur in the setting of progressive MS, to guide appropriate treatment or monitoring.

Highlights

Cervical spinal degenerative disease (SDD) and multiple sclerosis (MS) share clinical features, and misdiagnosis may occur
Myelopathic symptoms could result from spinal cord demyelination or compressive canal stenosis; in particular, lower cervical or thoracic disc protrusions are missed [6] in people with progressive MS because a gradually worsening spastic paraparesis with bladder disturbance is one of the main clinical features in progressive MS and the cord may not be routinely imaged during follow-up
In order to avoid selection biases, exclusion criteria for both groups comprised: (1) symptoms suggestive of cervical SDD at the time of imaging, since this study was conducted in a hospital population; (2) history of spinal trauma [15] or surgery [16] due to risk of subsequent SDD; and (3) known SDD in another spinal region, since this is associated with cervical SDD [17]

Summary

INTRODUCTION

Cervical spinal degenerative disease (SDD) and multiple sclerosis (MS) share clinical features, and misdiagnosis may occur. Lhermitte's sign can occur in cervical myelopathy [8] or milder forms of cervical SDD [9]. In both conditions, symptoms can come on sub-acutely and subsequently demonstrate a progressive course. Another study showed a high incidence of disc herniation (19.4%) in 330 PwMS, no control population was included [12]. It remains unclear whether foraminal and canal stenosis occurs more commonly in MS. We undertook a retrospective case–control study to compare the incidence of these and other types of SDD in progressive MS versus age-and sex-matched control subjects

METHODS

Study design

Findings

DISCUSSION