Should I see a neurosurgeon about walking?

Question:
I've been diagnosed with MS since 1999 and my EDDS is 7. My last MRI was October 2016 which showed a bulging disc at C5-6 with some cord impingement. There haven't been any changes in my MRI's since 2008 when I had a major exacerbation which sent me from a slight limp to a wheelchair /walker overnight. Since sometime last year - can't recall exactly when - my legs have become so much weaker. I can't use my walker at all, despite months of PT. My MS specialist suggested a consult with a neurosurgeon. I am very reluctant to have surgery. Do you think this could be causing the leg weakness?

Answer:
We call this a possible tandem lesion. A "Tandem lesion" is when there are 2 different problems (e.g. MS affecting the spinal cord plus compression of the spinal cord by a disc) affecting the same outcome; in your case worsening ambulation ability and increased numbness in the legs.

It is always difficult to determine if a disc pressing on the spinal cord is contributing to walking or spinal cord related problems when you’ve entered a progressive phase of the disease. This is for 2 major reasons:
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1. People with progressive MS often do not exhibit obvious new lesions (white spots) on MRI imaging over time and rarely show evidence of new enhancing lesions. However they do exhibit evidence for increased brain and spinal cord atrophy gradually over many years. This atrophy would not be noticed on yearly MRI scans but would be noticed if scans from now were compared to your scans in 2008

2. Disc bulging that deforms the spinal canal or even presses on the spinal cord is very common in people with or without MS and often causes no symptoms at all

Generally, I do not consider surgery on my progressive MS patients for disc related problems unless at least 1 of the following criteria are met:

1. There is refractory pain directly related to this disc related problem
2. There is severe cord compression with evidence of cord signal changes at the same level consistent ischemia or gliosis
3. There is acute spinal cord injury from trauma (these cases are obvious)

I also do not favor abrogating this decision to a neurosurgeon. Recovery from spine surgery can be difficult with many potential complications . These complications increase in patients with more severe MS.

Good luck and make sure you get several opinions if you feel uncomfortable with the recommendations provided.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego