Concomitant multiple sclerosis and cervical myelopathy: A propensity-matched QOD analysis of patient-reported outcomes and return to work after cervical spine surgery

Objective: The diagnosis of degenerative cervical myelopathy (CM) in multiple sclerosis (MS) patients is challenging due to overlapping symptomatology and radiological findings. Minimal literature reports patient reported outcomes measures (PROMs) for MS patients undergoing surgery for CM. Given the diagnostic difficulty, we aimed to determine if patients with MS have worse outcomes after elective cervical spine surgery.

Methods: 126 patients who underwent surgery for CM were retrospectively obtained from the Quality Outcomes Database (QOD). 63 MS patients were age and gender matched to 63 without MS. Postoperative PROMs including Visual Analogue Scale for neck/arm pain (VAS), Neck Disability Index (NDI), and satisfaction were compared at 3 and 12 months. Postoperative complications and return to work were studied as secondary outcomes.

Results: The average age of both cohorts was 57.9 years, and 63.5 % were female. Baseline functional status and symptomatology were similar, although fewer MS patients could independently ambulate (p = .014). The operative time and length of stay were similar. MS patients had a greater average ASA grade (p = 0.018), however there were no significant differences in VAS, NDI, or satisfaction. MS patients had a higher 3-month readmission rate (p = .044), however returned to work at a similar rate greater than 70 %.

Conclusion: PROMs do not significantly differ for CM patients with concomitant MS. Patients with MS had a higher 3-month complication rate, although readmissions were largely unrelated to the procedure. Thus, despite the diagnostic challenge of CM in MS patients, the surgical outcomes are comparable to those without MS.