Cervical Spondylosis Severity and Its Correlation with Clinical Parameters and Cervical Lesions in Multiple Sclerosis: A Cross-Sectional MRI Study

Background: The co-occurrence of multiple sclerosis (MS) and cervical spondylosis (CS) may not only intensify symptoms but also complicate the management of these disorders. Magnetic resonance imaging (MRI) is the preferred modality for detecting spinal cord lesions; however, there is limited evidence assessing myelopathy in concurrent CS and MS. Objectives: This study aims to evaluate the association between CS and its effects on the spinal cord, as well as their impact on enhancing MS cervical lesions. Methods: This cross-sectional study was conducted on 104 MS patients between 2019 and 2021. Data collected included age, gender, duration and phenotype of MS, and the Extended Disability Status Scale (EDSS). Magnetic resonance imaging images were obtained and analyzed for the presence of cervical spondylosis and demyelinated cervical plaques (active/inactive). Multiple sclerosis plaques were evaluated based on their extension, enhancement, and cervical location. Cervical spondylosis was categorized into four grades using the Muhle scale. Additionally, the spinal cord cross-sectional area (SC - CSA) was measured at the C2 - C3 cervical spine level. Results: The severity of cervical spondylosis was associated with older age (P-value < 0.001), longer duration of MS (P-value = 0.04), more severe EDSS scores (P-value = 0.03), and a lower C2 - C3 CS-CSA (P-value < 0.001). However, no significant associations were found with gender (P-value = 0.90), MS plaques activity (P-value = 0.25), or extension (P-value = 0.13). Conclusions: The study findings indicate that the severity of CS is associated with age, MS duration, EDSS, and the C2 - C3 cervical spine cross-sectional area. However, the study did not find evidence supporting a relationship between CS and the extension or activity of MS plaques.