Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: A cohort-controlled analysis

Daniel Lubelski, Kalil G. Abdullah, Matthew D. Alvin, Timothy Y. Wang, Amy S. Nowacki, Michael P. Steinmetz, Richard M. Ransohoff, Edward C. Benzel, Thomas E. Mroz

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background context The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. Purpose To define the demographic features and presenting symptoms of patients with both MS and CS and to investigate the immediate and long-term outcomes of surgery in patients with MS and CS. Study design/setting Matched cohort-controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and modified Japanese Orthopaedic Association scores were collected as well. Methods Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year. Results A total of 154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78% vs. 47%; p=.0001) and preoperative radiculopathy (90% vs. 75%; p=.03) than their counterparts in the MS group. Patients in the MS group had a significantly lower rate of postoperative resolution of myelopathic symptoms in both the short-term (39% in the MS group did not improve vs. 23% in the control group; p=.04) and the long-term (44% in the MS group did not improve vs. 19% in the control group; p=.004). Preoperative myelopathy scores were worse for the MS cohort as compared with the control cohort (1.8 vs. 1.2 in the Nurick scale, p<.0001; 13.7 vs. 15.0 in the modified Japanese Orthopaedic Association scale, p=.002). This difference in scores became even greater at the last follow-up visit with Nurick scores of 2.4 versus 0.9 (p<.0001) and modified Japanese Orthopaedic Association scores of 16.3 versus 12.4 (p<.0001) for the MS and control patients, respectively. Conclusions Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily because of progression of MS and that surgery can help alleviate neck pain and radicular symptoms.

Original languageEnglish (US)
Pages (from-to)331-337
Number of pages7
JournalSpine Journal
Volume14
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Fingerprint

Multiple Sclerosis
Pathologic Constriction
Cohort Studies
Spinal Cord Diseases
Neck Pain
Control Groups
Radiculopathy
Postoperative Pain
Decompression
Disease Progression

Keywords

  • Cervical stenosis
  • Multiple sclerosis
  • Myelopathy
  • Outcomes
  • Spinal cord compression
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis : A cohort-controlled analysis. / Lubelski, Daniel; Abdullah, Kalil G.; Alvin, Matthew D.; Wang, Timothy Y.; Nowacki, Amy S.; Steinmetz, Michael P.; Ransohoff, Richard M.; Benzel, Edward C.; Mroz, Thomas E.

In: Spine Journal, Vol. 14, No. 2, 01.02.2014, p. 331-337.

Research output: Contribution to journalArticle

Lubelski, D, Abdullah, KG, Alvin, MD, Wang, TY, Nowacki, AS, Steinmetz, MP, Ransohoff, RM, Benzel, EC & Mroz, TE 2014, 'Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: A cohort-controlled analysis', Spine Journal, vol. 14, no. 2, pp. 331-337. https://doi.org/10.1016/j.spinee.2013.11.012
Lubelski, Daniel ; Abdullah, Kalil G. ; Alvin, Matthew D. ; Wang, Timothy Y. ; Nowacki, Amy S. ; Steinmetz, Michael P. ; Ransohoff, Richard M. ; Benzel, Edward C. ; Mroz, Thomas E. / Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis : A cohort-controlled analysis. In: Spine Journal. 2014 ; Vol. 14, No. 2. pp. 331-337.
@article{957e676d9d2047b093f03f7454368713,
title = "Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: A cohort-controlled analysis",
abstract = "Background context The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. Purpose To define the demographic features and presenting symptoms of patients with both MS and CS and to investigate the immediate and long-term outcomes of surgery in patients with MS and CS. Study design/setting Matched cohort-controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and modified Japanese Orthopaedic Association scores were collected as well. Methods Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year. Results A total of 154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78{\%} vs. 47{\%}; p=.0001) and preoperative radiculopathy (90{\%} vs. 75{\%}; p=.03) than their counterparts in the MS group. Patients in the MS group had a significantly lower rate of postoperative resolution of myelopathic symptoms in both the short-term (39{\%} in the MS group did not improve vs. 23{\%} in the control group; p=.04) and the long-term (44{\%} in the MS group did not improve vs. 19{\%} in the control group; p=.004). Preoperative myelopathy scores were worse for the MS cohort as compared with the control cohort (1.8 vs. 1.2 in the Nurick scale, p<.0001; 13.7 vs. 15.0 in the modified Japanese Orthopaedic Association scale, p=.002). This difference in scores became even greater at the last follow-up visit with Nurick scores of 2.4 versus 0.9 (p<.0001) and modified Japanese Orthopaedic Association scores of 16.3 versus 12.4 (p<.0001) for the MS and control patients, respectively. Conclusions Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily because of progression of MS and that surgery can help alleviate neck pain and radicular symptoms.",
keywords = "Cervical stenosis, Multiple sclerosis, Myelopathy, Outcomes, Spinal cord compression, Surgery",
author = "Daniel Lubelski and Abdullah, {Kalil G.} and Alvin, {Matthew D.} and Wang, {Timothy Y.} and Nowacki, {Amy S.} and Steinmetz, {Michael P.} and Ransohoff, {Richard M.} and Benzel, {Edward C.} and Mroz, {Thomas E.}",
year = "2014",
month = "2",
day = "1",
doi = "10.1016/j.spinee.2013.11.012",
language = "English (US)",
volume = "14",
pages = "331--337",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis

T2 - A cohort-controlled analysis

AU - Lubelski, Daniel

AU - Abdullah, Kalil G.

AU - Alvin, Matthew D.

AU - Wang, Timothy Y.

AU - Nowacki, Amy S.

AU - Steinmetz, Michael P.

AU - Ransohoff, Richard M.

AU - Benzel, Edward C.

AU - Mroz, Thomas E.

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Background context The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. Purpose To define the demographic features and presenting symptoms of patients with both MS and CS and to investigate the immediate and long-term outcomes of surgery in patients with MS and CS. Study design/setting Matched cohort-controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and modified Japanese Orthopaedic Association scores were collected as well. Methods Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year. Results A total of 154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78% vs. 47%; p=.0001) and preoperative radiculopathy (90% vs. 75%; p=.03) than their counterparts in the MS group. Patients in the MS group had a significantly lower rate of postoperative resolution of myelopathic symptoms in both the short-term (39% in the MS group did not improve vs. 23% in the control group; p=.04) and the long-term (44% in the MS group did not improve vs. 19% in the control group; p=.004). Preoperative myelopathy scores were worse for the MS cohort as compared with the control cohort (1.8 vs. 1.2 in the Nurick scale, p<.0001; 13.7 vs. 15.0 in the modified Japanese Orthopaedic Association scale, p=.002). This difference in scores became even greater at the last follow-up visit with Nurick scores of 2.4 versus 0.9 (p<.0001) and modified Japanese Orthopaedic Association scores of 16.3 versus 12.4 (p<.0001) for the MS and control patients, respectively. Conclusions Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily because of progression of MS and that surgery can help alleviate neck pain and radicular symptoms.

AB - Background context The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. Purpose To define the demographic features and presenting symptoms of patients with both MS and CS and to investigate the immediate and long-term outcomes of surgery in patients with MS and CS. Study design/setting Matched cohort-controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and modified Japanese Orthopaedic Association scores were collected as well. Methods Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year. Results A total of 154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78% vs. 47%; p=.0001) and preoperative radiculopathy (90% vs. 75%; p=.03) than their counterparts in the MS group. Patients in the MS group had a significantly lower rate of postoperative resolution of myelopathic symptoms in both the short-term (39% in the MS group did not improve vs. 23% in the control group; p=.04) and the long-term (44% in the MS group did not improve vs. 19% in the control group; p=.004). Preoperative myelopathy scores were worse for the MS cohort as compared with the control cohort (1.8 vs. 1.2 in the Nurick scale, p<.0001; 13.7 vs. 15.0 in the modified Japanese Orthopaedic Association scale, p=.002). This difference in scores became even greater at the last follow-up visit with Nurick scores of 2.4 versus 0.9 (p<.0001) and modified Japanese Orthopaedic Association scores of 16.3 versus 12.4 (p<.0001) for the MS and control patients, respectively. Conclusions Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily because of progression of MS and that surgery can help alleviate neck pain and radicular symptoms.

KW - Cervical stenosis

KW - Multiple sclerosis

KW - Myelopathy

KW - Outcomes

KW - Spinal cord compression

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84892812665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892812665&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2013.11.012

DO - 10.1016/j.spinee.2013.11.012

M3 - Article

C2 - 24239804

AN - SCOPUS:84892812665

VL - 14

SP - 331

EP - 337

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

IS - 2

ER -