Surgical Management of Multiple Sclerosis and Comorbid Conditions

Multiple sclerosis (MS) is primarily managed through immunomodulatory and symptomatic therapies, yet a substantial subset of patients develop concurrent spinal degenerative or compressive pathology that exacerbates neurological impairment. Surgical intervention in this context aims to alleviate mechanical compression, restore spinal alignment and improve functional outcomes, while carefully distinguishing surgical targets from demyelinating lesions. Common indications include cervical spondylotic myelopathy, foraminal stenosis and ossification of the posterior longitudinal ligament, all of which may mimic or compound MS flares. A multidisciplinary pathway involving neurologists, neuroradiologists, anaesthetists and spine surgeons is essential to optimise timing of surgery, minimise perioperative risk and tailor anaesthetic and analgesic regimens. Recent advances in intraoperative neurophysiological monitoring and high-resolution imaging have enhanced patient selection and postoperative recovery. Moreover, emerging awareness of neuromyelitis optica spectrum disorders as masqueraders of compressive pathology highlights the need for serological testing when imaging findings and clinical course diverge. Effective surgical management in MS requires a balance between decompression of structural lesions and preservation of demyelinated neural tissue, underpinned by vigilant perioperative care and coordinated long-term rehabilitation.

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Surgical Management of Multiple Sclerosis and Comorbid Conditions publication trend

The graph below shows the total number of articles in surgical management of multiple sclerosis and comorbid conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Cervical spondylotic myelopathy: Compression of the cervical spinal cord due to degenerative changes in vertebral discs and ligaments.

Foraminal stenosis: Narrowing of the lateral spinal nerve exit channels, often causing radiculopathy.

Decompressive surgery: Surgical removal of bone or ligamentous tissue to relieve pressure on neural elements.

Neuromyelitis optica spectrum disorder (NMOSD): An autoimmune demyelinating condition distinct from MS, associated with aquaporin-4 antibodies and often involving longitudinally extensive spinal lesions.

References

1. Cervical spinal degenerative disease in multiple sclerosis. European Journal of Neurology (2021).
2. Compressive Cervical Myelopathy in Patients With Demyelinating Disease of the Central Nervous System: Improvement After Surgery Despite a Late Diagnosis. Cureus (2021).
3. Neuromyelitis Optica Spectrum Disorders (NMOSDs) Diagnosed After Surgery for the Ossification of the Posterior Longitudinal Ligament of the Cervical and Thoracic Spine: A Case Report. Cureus (2024).