How do you determine if your MS symptoms are not from cervical spondylosis, cervical herniated disc, or kyphosis?

Here is My Question:
How do you determine if your MS symptoms are not from cervical spondylosis, cervical herniated disc, or kyphosis? I have a lot of cervical issues that have not been addressed and was only given MRI. I read that cervical issues could cause white matter changes in MRI. I also experience menstrual migraines. How do I know if my diagnosis is correct?

Answer:
It can be difficult to determine the cause of spinal cord symptoms, also called a myelopathy, particularly when the symptoms occur in middle aged or elderly individuals. Both degenerative disc disease and arthritis involving the cervical spine increase with age and may cause some impingement or frank compression of the spinal cord.

Whether this compression causes any symptoms depends on how quickly it develops and whether there is compression of blood flow to the spinal cord. MRI scans can determine the degree of spinal cord compression and occasionally determine if there is limitation of blood flow or a contusion in the spinal cord. More commonly, we are able to see narrowing of the spinal cord canal space and flattening of the spinal cord at one or more levels but without any other alterations in the imaging characteristics of the spinal cord.

In these cases, it takes a skilled neurologist using features of your history and examination to determine the likelihood that the compression observed on the MRI scan is responsible for your symptoms. This is most difficult in cases where there is also obvious involvement of the spinal cord by a disease such as multiple sclerosis. Some things to consider are the following:

1. Most cases (85-90 %) of Multiple sclerosis are relapsing in onset. This means that symptoms emerge rapidly over several days, stabilize and then spontaneously improve to some degree. This process may be repeated over many years
2. Most cases of cervical myelopathy from cord compression occur very slowly and worsen in a stuttering fashion over many months or years. This is very different than relapsing MS but is often confused with primary progressive MS, a less common form of the disease affecting 10-15 % of all cases. It is particularly confusing when a person has both primary progressive MS and compressive cervical myelopathy. In this case we are often asked as MS specialists to predict if an operation would benefit the individual. In these cases we may recommend a decompressive laminectomy if the compression is significant and there is reason to believe that decompression has a significant chance of improving symptoms; longer duration of significant deficits (> 18 months) and older age are associated with poorer outcomes from surgery.

Hope this helps.

Revere P (Rip) Kinkel, MDProfessor of Neurosciences
Director of the Multiple Sclerosis Program
University of California San Diego
#multiplesclerosis