Surgical management of patients with coexistent multiple sclerosis and cervical stenosis: A systematic review and meta-analysis

Abstract

Multiple sclerosis (MS) and cervical stenosis (CS) are two unique pathologies that can present with overlapping symptoms. In patients with concurrent MS and CS, the exact cause for worsening of symptoms is often difficult to decipher. In this study, we aimed to review the medical literature on the benefits of surgical decompression surgery in patients with coexisting CS and MS. We systematically reviewed the literature for articles published prior to December 1st, 2018 describing outcomes (improvement of symptoms of radiculopathy, myelopathy, and neck pain) in patients with coexisting MS and CS undergoing cervical decompression surgery. Effect sizes were calculated demonstrating the effect of surgical decompression on improving symptoms. We identified eight articles that satisfied our selection criteria, of which six provided data regarding symptoms after surgery. Our meta-analysis indicates that cervical decompression surgery in patients with coexisting MS and CS is beneficial in improving symptoms of myelopathy (ES 0.74, 95% CI 0.38-1.10, p < 0.0001), radiculopathy (ES 1.29, 95% CI 0.15-2.42, p < 0.001), and neck pain (ES 1.66, 95% CI 1.02-2.31, p < 0.0001). Our meta-analysis indicates that there is paucity of high level of evidence studies regarding the benefit of cervical decompression surgery in patients with concomitant CS and MS. However, the literature suggests that cervical decompression may be beneficial to such patients, providing stabilization or improvement in symptoms of myelopathy, radiculopathy, and neck pain. Spine surgeons must carefully delineate the cause of symptoms in patients to decide whether this is the optimal treatment for each individual patient.

Keywords: Cervical stenosis; Coexistent; Decompression; Multiple sclerosis.