Surgical Treatment of Patients With Cervical Myeloradiculopathy and Coexistent Multiple Sclerosis

Abstract

A case series of 15 patients. To report a series of patients with coexisting multiple sclerosis (MS) and progressive myeloradiculopathy who were successfully treated with surgical decompression, fusion, and fixation. MS and cervical myeloradiculopathy share clinical signs, including gait dysfunction, motor weakness, and hyperreflexia. Distinguishing between these 2 entities may be difficult, and in rare cases they may coexist. Controversy exists regarding the use of surgery in patients with MS as a treatment for degenerative cervical spondylotic disease. This case series was composed of 15 patients (10 female, 5 male, average age 50.1 y) with a confirmed diagnosis of MS, who presented with worsening cervical myeloradiculopathy. Outcome measures included neurologic assessment, subjective reports of pain and paraesthesias, and radiographic fusion rates. The patients had neurologic findings consistent with both diseases, and some had radicular findings associated with degenerative disk disease. All patients had magnetic resonance evidence of cervical spinal cord or nerve root compression from an abnormal disk/osteophyte complex, hypertrophied ligament, or both. The average follow-up was 47 months. Thirteen patients showed objective improvement in neurologic function, including increased lower and upper extremity strength. Two patients' symptoms stabilized. Thirteen of 15 patients also had improvement in neck and/or upper extremity pain or paresthesias; 2 patients had continuing upper and lower extremity paresthesias. The patient with bladder incontinence had no improvement of this problem. All patients went on to radiographic fusion. There were no surgical complications. Patients with coexistent MS and cervical myeloradiculopathy may present a diagnostic challenge, and it may be difficult to ascertain the exact disease pathophysiology. However, patients with MS and degenerative cervical spondylotic disease can benefit from surgical decompression. Surgery is an efficacious, low-risk procedure, and should be offered to appropriately selected patients who harbor both the diseases.