What are the different vertebrae and associated Multiple Sclerosis (MS) symptoms if a lesion is present?

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From the Guidelines

Multiple Sclerosis (MS) Lesions and Associated Symptoms by Vertebrae The presence of a lesion in the cervical, thoracic, or lumbar vertebrae can cause various symptoms in Multiple Sclerosis (MS) patients, including numbness, weakness, and bladder or bowel dysfunction, depending on the location and extent of the lesion 1.

Cervical Vertebrae

  • Lesions in the cervical vertebrae can cause symptoms such as numbness or weakness in the arms or legs, difficulty with balance or coordination, and bladder or bowel dysfunction 1.
  • The cervical cord is the most common site for MS lesions, and lesions in this region can be associated with a higher risk of conversion to clinically definite MS 1.

Thoracic Vertebrae

  • Lesions in the thoracic vertebrae can cause symptoms such as numbness or weakness in the trunk or legs, difficulty with balance or coordination, and bladder or bowel dysfunction 1.
  • Thoracic cord lesions are less common than cervical cord lesions but can still be associated with significant symptoms and disability 1.

Lumbar Vertebrae

  • Lesions in the lumbar vertebrae can cause symptoms such as numbness or weakness in the legs, difficulty with balance or coordination, and bladder or bowel dysfunction 1.
  • Lumbar cord lesions are less common than cervical or thoracic cord lesions but can still be associated with significant symptoms and disability 1.

Key Characteristics of MS Lesions

  • MS lesions are typically small (at least 3 mm), covering less than two vertebral segments, and usually less than half of the cord area 1.
  • Lesions are often located in the periphery of the spinal cord, mainly in the lateral or dorsal columns, but can affect the anterior white matter and the central grey matter 1.
  • Focal lesions strictly confined to the grey matter are unusual in MS 1.
  • Active MS spinal cord lesions enhance less frequently than brain lesions, and when enhancement is present, it is typically short-lived (2-8 weeks) and nodular 1.

Red Flags for Spinal Cord Lesions

  • Longitudinally extensive lesions extending over three or more vertebral segments 1.
  • Prominent involvement of the central grey matter 1.
  • Swelling of the spinal cord (neuromyelitis optica spectrum disorders, anti-MOG-IgG disease) 1.
  • Preferential involvement of the most caudal portion of the spine (anti-MOG-IgG disease) 1.
  • Leptomeningeal or nerve root involvement (neurosarcoidosis, infectious disease, malignancies) 1.
  • Cavitation (syringohydromyelia) 1.
  • The presence of long and selective involvement of white matter columns (metabolic diseases such as vitamin B12 or copper deficiency) 1.
  • Evidence of micro/macrobleeds (arteriovenous fistula) 1.
  • Lesions affecting the anterior two-thirds of the spinal cord with the so-called ‘snake eye’ or ‘owl’s eye’ sign of bilateral hyperintensities of the anterior grey matter horns (ischaemia or infarction) 1.
  • The presence of spinal cord compression as occurring in spondylotic myelopathy 1.

From the Research

Vertebrae and Associated Multiple Sclerosis (MS) Symptoms

The different vertebrae and associated MS symptoms if a lesion is present are:

  • Cervical vertebrae (C3-C5): lesions in this region are common, with 60% of intrinsic focal lesions located at these levels 2
  • Thoracic vertebrae: lesions in this region are influenced by the degree of cervical spine involvement in MS, with an increased odds ratio of thoracic spine involvement when any cervical spine lesion is present 3
  • Lumbar vertebrae: not specifically mentioned in the provided studies, but spinal cord atrophy and lesions can occur in any region of the spinal cord

MS Symptoms Associated with Lesions

MS symptoms associated with lesions in different vertebrae include:

  • Motor progression: 'critical' demyelinating lesions along spinal cord corticospinal tracts are anatomically consistent with and may be disproportionately associated with motor progression 4
  • Disability: the spinal cord is an area where threshold impairment associates with MS disability, and progressive spinal cord atrophy may be an important MS prognostic biomarker 4
  • Spasticity: spasticity induced by brain lesions and abnormal expression of extracellular matrix proteins in the brain and the intervertebral disk may contribute to the development of spondylosis in MS patients 5

Lesion Characteristics

Lesion characteristics, such as size and location, can vary depending on the clinical form of MS:

  • Focal lesions: more common in patients with benign MS, with medium-sized lesions prevailing 2
  • Diffuse lesions: more common in patients with primary progressive MS and secondary progressive MS, with large lesions (>10 mm) more frequent in secondary progressive MS 2
  • Spinal cord atrophy: more frequent in patients with primary progressive MS and secondary progressive MS, but not accompanied by intrinsic focal cord lesions 2

References

1
Guideline

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Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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