Surgery for cervical spinal cord compression in patients with multiple sclerosis

OBJECTIVE: The goal of this study was to investigate the clinical and parac linical features, treatment, and outcomes of patients with multiple scleros is (MS) and coexisting spinal cord compression secondary to either cervical spondylosis or cervical disc disease. Patients with MS commonly experience neurological disabilities that present as myelopathy associated with bladd er dysfunction. For some patients with MS, however, this neurological deter ioration may result from coexisting spinal cord compression attributable to either spondylosis or a herniated disc. Overlapping symptoms of the two co nditions do not allow clear clinical determination of the underlying cause of worsening. METHODS: Patients with MS who underwent cervical decompression surgery were selected. Medical records were retrospectively reviewed, to collect data o n their pre- and postoperative clinical courses. RESULTS: Nine women and five men with definite MS were selected for cervica l decompression surgery to treat neurological deterioration considered to b e at least partially attributable to spinal cord compression. The most comm on symptoms were progressive myelopathy (n = 13), neck pain (n = 11), and c ervical radiculopathy (n = 10). Bladder dysfunction was notably absent amon g these patients with MS with moderate disabilities. Surgical intervention was frequently delayed because the neurological deterioration was initially thought to be attributable to MS. The majority of patients experienced eit her improvement or stabilization of their preoperative symptoms in the imme diate postoperative period; three subjects (21%) maintained this improvemen t after a mean follow-up period of 3.8 years. No MS relapses, permanent neu rological worsening, or serious complications resulting from surgery or gen eral anesthesia were noted. CONCLUSION: Carefully selected patients with MS and cervical spinal cord co mpression secondary to either spondylosis or disc disease may benefit from surgical decompression, with minimal associated morbidity. Clinical feature s (especially neck pain and cervical radiculopathy) and magnetic resonance imaging may assist clinicians in differentiating between the two conditions and may guide appropriate treatment without undue delay.