Findings support surgery for patients with both cervical stenosis and multiple sclerosis

There was more postoperative neck pain and radiculopathy in control group patients than in patients with coexisting cervical stenosis and multiple sclerosis.

Issue: April 2014

Recently presented research indicates that patients with coexisting multiple sclerosis and cervical stenosis benefit from surgical intervention.

“Surgery should be considered for patients with multiple sclerosis and cervical stenosis because most patients did improve following surgery,” study presenter Daniel Lubelski, BA, a medical student at Cleveland Clinic Lerner College of Medicine, Ohio, said.

Lubelski and colleagues conducted a retrospective review of the medical records for 77 patients with coexisting cervical stenosis and multiple sclerosis (MS) and matched their gender, age, and procedure type with a control group of 77 patients who had cervical stenosis but not MS. All patients underwent treatment at Cleveland Clinic between 1996 and 2011 and the average follow-up for both groups was 4 years.

This patient had concurrent multiple sclerosis
and cervical stenosis with myelopathy.

Image: Lubelski D

The preoperative Nurick scale score was 1.8 points in the MS and cervical stenosis group vs. 1.2 points in the control group. Modified Japanese Orthopaedic Association (mJOA) scores were 13.7 points in the MS and cervical stenosis group and 15.0 points in the control group. At latest follow-up, the Nurick scale score was 2.4 points in the MS and cervical stenosis group compared to 0.9 points in the control group. The mJOA score was 16.3 points in the MS and cervical stenosis group and 12.4 points in the control group.

Patients in the control group frequently presented to the clinician with different complaints as compared to those in the MS and cervical stenosis group, according to Lubelski. The researchers found 78% of patients in the control group had preoperative neck pain vs. 47% in the MS and cervical stenosis group. Preoperative radiculopathy was in 90% of patients in the control group vs. 47% in the MS and cervical stenosis group.

Regarding postoperative complications, Lubelski said that there were no acute postoperative exacerbations of multiple sclerosis.

Postoperatively, myelopathic symptoms remained in 39% of patients in the MS and cervical stenosis group vs. 23% in the control group in the short-term; in the long-term, 44% of patients in the MS and cervical stenosis group remained myelopathic compared to 19% of patients in the control group.

The relapsing remitting subtype of patients with MS showed better outcomes than other subtypes after surgery, according to Lubelski. – by Renee Blisard Buddle

Reference:

Lubelski D. Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: A cohort controlled analysis. Presented at: North American Spine Society Annual Meeting; Oct. 9-12; New Orleans.

For more information:

Daniel Lubelski, BA, can be reached at the Cleveland Clinic Lerner College of Medicine, Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-40, Cleveland, OH 44195; email: dlubelski@gmail.com.
Disclosure: Lubelski has no relevant financial disclosures.