Cervical lesions predict thoracic spine involvement in MS

By Reuters Staff

NEW YORK (Reuters Health) - In patients with multiple sclerosis (MS), the presence of cervical spine lesions may predict thoracic spine involvement in the disease, new research suggests.

"Our study reiterates that relying on brain lesions and clinical symptoms may not be sufficient in determining thoracic spine involvement," Dr. Le Hua, a neurologist at the Cleveland Clinic's Lou Ruvo Center for Brain Health in Las Vegas, Nevada, and colleagues write in an article online January 13 in Spinal Cord.

Involvement of the spinal cord in MS is associated with disability outcomes and higher rates of conversion to clinically definite MS, plus a risk for a first clinical event relevant to central nervous system demyelination in isolated syndromes, the researchers note.

Dr. Hua and colleagues analyzed records of all MS patients at an Arizona clinic who underwent magnetic resonance imaging (MRI) of the brain, cervical spine, and thoracic spine in single scanning sessions during 2012.

In the final analysis involving 126 patients, they found that any cervical spine lesion increased the odds ratio more than sixfold of thoracic spine involvement (p<0.001).

Furthermore, on multivariate logistic regression analysis, they found that odds for thoracic spine involvement increased fast when two or more cervical spine lesions are present.

For example, the OR was 4.44 (p=0.06) with two lesions and 19.76 (p=0.001) with three; in patients with diffuse lesions, the OR was 71.94 (p=0.001).

In that analysis, the researchers adjusted for covariates including clinical symptoms, brain lesions, disease duration and treatment exposure.

The study population consisted mostly of women (74.6%), whites (61.9%), and relapsing-remitting (90.5%) patients aged 14-71 years. The MRI scans took place at diagnosis for 35% of the patients, and the most common clinical symptom before or at first spinal MRI was impaired sensation (77%).

"Our results suggest an increase in risk for the presence of thoracic spine lesions when one or more lesions are present within the cervical spinal cord," the researchers write. "Importantly, this observation was found to be independent of the number of brain lesions, treatment exposure, clinical symptoms and disease duration from first symptom onset."

Assessment of spinal cord lesions at diagnosis or throughout the course of the disease is important in counseling patients, making treatment recommendations and assessing future disability, the researchers write.

They conclude, "Future efforts should be directed toward evaluating the utility of not only cervical imaging but also thoracic spinal cord imaging and the correlates to disability progression."

SOURCE: http://bit.ly/1zxleIo

Spinal Cord 2015.

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