Clinical Neurology and Neurosurgery 121 (2014) 23–26
Contents lists available at ScienceDirect
Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro
Is there any relation between cervical cord plaques and discopathy in patients with multiple sclerosis? Alireza Nikseresht a , Maryam Sharifian b,∗ , Sadegh Izadi c , Alireza Hamidian Jahromi d , Abbas Rezaianzadeh e a
Shiraz University of Medical Sciences, Shiraz, Iran Resident of Neurology, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran c Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran d Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, USA e Research Centre for Health Sciences, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran b
a r t i c l e
i n f o
Article history: Received 17 November 2012 Received in revised form 11 January 2014 Accepted 10 March 2014 Available online 19 March 2014 Keywords: Cervical cord lesions Discopathy Multiple sclerosis Spinal cord symptoms MRI
a b s t r a c t Introduction: Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system. The purpose of this study is to determine the relationship between the site of the cervical discopathy and cervical spinal cord plaque in MS patients. Methods: This retrospective study included all patients with a definite diagnosis of MS who were treated at an outpatient clinic between September 2004 and September 2011. All patients underwent cervical magnetic resonance imaging (MRI) for primary investigation of the disease. Cervical MRI scans were evaluated for detection of any evidence of cervical discopathy and cervical MS plaques. Any correlation between the site of the MS lesions and discopathy was recorded. Results: From 536 patients who were involved in the study, 214 patients had both cervical discopathy and cervical cord plaques. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy. The number of patients with cervical cord plaque and discopathy at same site was significantly higher than those with plaque and discopathy at different sites (P < 0.05). Conclusion: The study data suggests a possible correlation between cervical discopathy and cervical MS plaque. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system (CNS). MS affects predominantly the white matter of the brain and also some parts of the grey matter [1,2]. It is one of the most important causes of non-traumatic disability in adults especially females, affecting about 2 million people worldwide [3]. The primary diagnosis of MS and further monitoring and followup of the disease is based on central nervous system magnetic resonance imaging (MRI) findings, which allow an early diagnosis of MS according to the diagnostic criteria [4,5]. It has been proposed that neuro-axonal loss is the leading cause of permanent disability
∗ Corresponding author at: Resident of Neurology, Department of Neurology, Nemazi Hospital, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98 9177133608. E-mail address: Maryam sharifi[email protected] (M. Sharifian). http://dx.doi.org/10.1016/j.clineuro.2014.03.015 0303-8467/© 2014 Elsevier B.V. All rights reserved.
that occurs in the primary stages of the disease [6,7]. Molecular and cellular mechanisms contributing to neurodegeneration are still poorly understood [8]. Disk herniation may coexist with MS and may distort the diagnosis [9]. It seems that compression of the cervical spinal cord secondary to cervical spondylosis or disk herniation may result in acute or chronic myelopathy [9]. Terminology of disk herniation describes an intact but thinned annulus fibrosus or frank rupture and extrusion of nucleus pulposus through the site of the defect. Herniation occurs most commonly at the level of C5–C6 and C6–C7 [10,11]. In this study, cervical discopathy is characterized by thinning and protrusion of an intervertebral disk, herniation of nucleus pulposus, and new bone formation involving apophyseal joints and adjacent vertebrae [12]. The purpose of this study is to determine the relationship between the site of cervical discopathy and cervical spinal cord plaque (which are especially common in the cervical cord opposite the C2 or C3 vertebra) [13] in an outpatient clinic for MS patients.
24
A. Nikseresht et al. / Clinical Neurology and Neurosurgery 121 (2014) 23–26
2. Patients and methods All patients with a definite diagnosis of MS who were visited at the outpatient clinic between September 2004 and September 2011 were included in this retrospective study. All referred patients were visited by an expert neurologist and if the definite diagnosis of MS were reached based on the McDonald criteria, they were included in this study [14]. All patients received the required treatment according to their condition. Using a data collection form, demographic data and information on the primary presentation of the disease, history and type of attacks and treatments were gathered. All patients underwent a cervical MRI for primary investigation of the disease and again during the study when the patients had any new complaint. The MRI of the patients was reviewed for detection of cervical cord lesions and any sign of cervical discopathy. We had two reviewers, first the radiologist of the MRI center, who is expert in this field and also the neurologist who visited the patients. We reviewed the abnormal MRIs with the other radiologist for confirmation of both discopathy and plaque. We selected the patients with both cervical cord plaques and cervical discopathy, then we divided these patients into two groups, the patients whose cervical plaques and discopathy were in the same site (Group 1) and the patients with plaques and discopathy in different sites (Group 2). Any correlation between the site of lesion and discopathy was investigated. The patients who were diagnosed as CIS (clinically isolate syndrome) or RIS (radiological isolated syndrome) were excluded from the study. The patients with Expanded Disability Status Scale (EDSS) more than 6 were excluded from the study too. The patients with remitting-relapsing MS and progressive MS were included. We also investigated the presence of correlation between discopathy and cervical cord plaques in these groups of the patients too. The study was approved by the Institutional Review Board and the Ethics Committee of Shiraz University of Medical Sciences. All of the patients gave informed consent to be included in this study. Descriptive statistics and chi-squared test by SPSS software version 15 were used for statistical analysis. A P-value of less than 0.05 was considered to be statistically significant.
3. Results Overall, 536 patients (female = 441 [82.3%]; other males [17.7%]; mean age = 30.2 years; ranges: 16–61 years) were involved in this study. Of these patients, 471 (87.9%) of them had cervical cord plaques on cervical MRI. Both discopathy and cervical plaques were seen in 214 (39.9%) of the patients. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy (Group 1). In 66 patients, cervical plaque and discopathy did not have any correlation regarding the site of the lesion (Group 2). The number of patients with plaque and discopathy at same site (Group 1) was significantly higher than those with plaque and discopathy at different sites (Group 2) (Table 1) (P < 0.05). There was not significant correlation between sex of the patients and presence of discopathy in this study, but there was a significant positive correlation between age and presence of cervical discopathy and also cervical disk plaques (P < 0.05). Presence of spinal cord signs and symptoms was significantly higher among the patients with cervical cord plaques; interestingly the patients with both cervical discopathy and cervical plaques had more spinal cord signs than the patients with only cervical cord plaques (P < 0.05).
Table 1 Prevalence of cervical core lesions and discopathy in the patients. Characteristics of the patient (N = 536)
Count (%)
Cervical discopathy Cervical cord plaques Cervical plaque and discopathy in the same level
214 (39.9%) 471 (87.8%) 148 (31.4%) (percent compared to the total patients with cervical plaques) 66 (14%) (percent compared to the total patients with cervical plaques)
Cervical plaque and discopathy in different level
P-value
Contents lists available at ScienceDirect
Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro
Is there any relation between cervical cord plaques and discopathy in patients with multiple sclerosis? Alireza Nikseresht a , Maryam Sharifian b,∗ , Sadegh Izadi c , Alireza Hamidian Jahromi d , Abbas Rezaianzadeh e a
Shiraz University of Medical Sciences, Shiraz, Iran Resident of Neurology, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran c Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran d Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, USA e Research Centre for Health Sciences, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran b
a r t i c l e
i n f o
Article history: Received 17 November 2012 Received in revised form 11 January 2014 Accepted 10 March 2014 Available online 19 March 2014 Keywords: Cervical cord lesions Discopathy Multiple sclerosis Spinal cord symptoms MRI
a b s t r a c t Introduction: Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system. The purpose of this study is to determine the relationship between the site of the cervical discopathy and cervical spinal cord plaque in MS patients. Methods: This retrospective study included all patients with a definite diagnosis of MS who were treated at an outpatient clinic between September 2004 and September 2011. All patients underwent cervical magnetic resonance imaging (MRI) for primary investigation of the disease. Cervical MRI scans were evaluated for detection of any evidence of cervical discopathy and cervical MS plaques. Any correlation between the site of the MS lesions and discopathy was recorded. Results: From 536 patients who were involved in the study, 214 patients had both cervical discopathy and cervical cord plaques. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy. The number of patients with cervical cord plaque and discopathy at same site was significantly higher than those with plaque and discopathy at different sites (P < 0.05). Conclusion: The study data suggests a possible correlation between cervical discopathy and cervical MS plaque. © 2014 Elsevier B.V. All rights reserved.
1. Introduction Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system (CNS). MS affects predominantly the white matter of the brain and also some parts of the grey matter [1,2]. It is one of the most important causes of non-traumatic disability in adults especially females, affecting about 2 million people worldwide [3]. The primary diagnosis of MS and further monitoring and followup of the disease is based on central nervous system magnetic resonance imaging (MRI) findings, which allow an early diagnosis of MS according to the diagnostic criteria [4,5]. It has been proposed that neuro-axonal loss is the leading cause of permanent disability
∗ Corresponding author at: Resident of Neurology, Department of Neurology, Nemazi Hospital, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98 9177133608. E-mail address: Maryam sharifi[email protected] (M. Sharifian). http://dx.doi.org/10.1016/j.clineuro.2014.03.015 0303-8467/© 2014 Elsevier B.V. All rights reserved.
that occurs in the primary stages of the disease [6,7]. Molecular and cellular mechanisms contributing to neurodegeneration are still poorly understood [8]. Disk herniation may coexist with MS and may distort the diagnosis [9]. It seems that compression of the cervical spinal cord secondary to cervical spondylosis or disk herniation may result in acute or chronic myelopathy [9]. Terminology of disk herniation describes an intact but thinned annulus fibrosus or frank rupture and extrusion of nucleus pulposus through the site of the defect. Herniation occurs most commonly at the level of C5–C6 and C6–C7 [10,11]. In this study, cervical discopathy is characterized by thinning and protrusion of an intervertebral disk, herniation of nucleus pulposus, and new bone formation involving apophyseal joints and adjacent vertebrae [12]. The purpose of this study is to determine the relationship between the site of cervical discopathy and cervical spinal cord plaque (which are especially common in the cervical cord opposite the C2 or C3 vertebra) [13] in an outpatient clinic for MS patients.
24
A. Nikseresht et al. / Clinical Neurology and Neurosurgery 121 (2014) 23–26
2. Patients and methods All patients with a definite diagnosis of MS who were visited at the outpatient clinic between September 2004 and September 2011 were included in this retrospective study. All referred patients were visited by an expert neurologist and if the definite diagnosis of MS were reached based on the McDonald criteria, they were included in this study [14]. All patients received the required treatment according to their condition. Using a data collection form, demographic data and information on the primary presentation of the disease, history and type of attacks and treatments were gathered. All patients underwent a cervical MRI for primary investigation of the disease and again during the study when the patients had any new complaint. The MRI of the patients was reviewed for detection of cervical cord lesions and any sign of cervical discopathy. We had two reviewers, first the radiologist of the MRI center, who is expert in this field and also the neurologist who visited the patients. We reviewed the abnormal MRIs with the other radiologist for confirmation of both discopathy and plaque. We selected the patients with both cervical cord plaques and cervical discopathy, then we divided these patients into two groups, the patients whose cervical plaques and discopathy were in the same site (Group 1) and the patients with plaques and discopathy in different sites (Group 2). Any correlation between the site of lesion and discopathy was investigated. The patients who were diagnosed as CIS (clinically isolate syndrome) or RIS (radiological isolated syndrome) were excluded from the study. The patients with Expanded Disability Status Scale (EDSS) more than 6 were excluded from the study too. The patients with remitting-relapsing MS and progressive MS were included. We also investigated the presence of correlation between discopathy and cervical cord plaques in these groups of the patients too. The study was approved by the Institutional Review Board and the Ethics Committee of Shiraz University of Medical Sciences. All of the patients gave informed consent to be included in this study. Descriptive statistics and chi-squared test by SPSS software version 15 were used for statistical analysis. A P-value of less than 0.05 was considered to be statistically significant.
3. Results Overall, 536 patients (female = 441 [82.3%]; other males [17.7%]; mean age = 30.2 years; ranges: 16–61 years) were involved in this study. Of these patients, 471 (87.9%) of them had cervical cord plaques on cervical MRI. Both discopathy and cervical plaques were seen in 214 (39.9%) of the patients. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy (Group 1). In 66 patients, cervical plaque and discopathy did not have any correlation regarding the site of the lesion (Group 2). The number of patients with plaque and discopathy at same site (Group 1) was significantly higher than those with plaque and discopathy at different sites (Group 2) (Table 1) (P < 0.05). There was not significant correlation between sex of the patients and presence of discopathy in this study, but there was a significant positive correlation between age and presence of cervical discopathy and also cervical disk plaques (P < 0.05). Presence of spinal cord signs and symptoms was significantly higher among the patients with cervical cord plaques; interestingly the patients with both cervical discopathy and cervical plaques had more spinal cord signs than the patients with only cervical cord plaques (P < 0.05).
Table 1 Prevalence of cervical core lesions and discopathy in the patients. Characteristics of the patient (N = 536)
Count (%)
Cervical discopathy Cervical cord plaques Cervical plaque and discopathy in the same level
214 (39.9%) 471 (87.8%) 148 (31.4%) (percent compared to the total patients with cervical plaques) 66 (14%) (percent compared to the total patients with cervical plaques)
Cervical plaque and discopathy in different level
P-value
