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MS vs Cervical Spondylotic Myelopathy — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS vs Cervical Spondylotic MyelopathySCE Neurology

A 55-year-old man with known MS develops a progressive myelopathy. His MRI spine shows a new lesion but also extensive cervical spondylosis with cord compression. His neurologist needs to determine whether his progression is due to MS or cervical spondylotic myelopathy. What clinical features help distinguish the two?

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Correct answer: B — Lhermitte sign, bladder symptoms, and sensory level occur in both; however, LMN signs at the level of compression (absent reflex, wasting at C5/6/7) with UMN below favour spondylotic myelopathy, while disseminated lesions on brain MRI, OCBs, and non-segmental sensory findings favour MS — both can coexist and contribute

Distinguishing MS from cervical spondylotic myelopathy is challenging as both cause progressive spastic paraparesis with sensory disturbance and bladder dysfunction. Features favouring spondylosis: dermatomal sensory loss, segmental LMN signs at the level of compression, pain with neck movement, and absence of brain lesions. Features favouring MS: disseminated brain lesions, positive OCBs, relapsing-remitting history, optic nerve involvement, non-dermatomal sensory patterns. Importantly, both conditions can COEXIST — having MS does not protect against spondylosis, and both may need addressing. A: Clinical features can help distinguish. C: Clinical assessment is also important. D: CSF helps but is not the only factor. E: MRI is also important.

Reference: NICE NG100 MS; AO Spine Guidelines