From the Guidelines
The cervical spine location is most commonly associated with MS lesions causing intermittent heavy leg sensation.
Key Characteristics of MS Lesions in the Spine
- MS lesions can occur anywhere in the CNS, but they tend to affect specific white matter regions, such as the periventricular and juxtacortical white matter, the corpus callosum, infratentorial areas, and the spinal cord (preferentially the cervical segment) 1.
- Spinal cord lesions are often small (but at least 3 mm), covering less than two vertebral segments and usually less than half of the cord area 1.
- Focal lesions strictly confined to the grey matter are unusual in multiple sclerosis, and most lesions are located in the periphery of the spinal cord, mainly in the lateral or dorsal columns 1.
Diagnostic Criteria for MS Lesions in the Spine
- One spinal cord lesion can be substituted for one brain lesion in the diagnostic criteria for MS 1.
- Spinal cord lesions detected by MRI might supplement incomplete information from brain MRI scans, especially in clinically isolated syndromes or when disease is progressive from onset 1.
- The characteristics and distribution of spinal cord lesions in MS are well-described, and their absence in healthy controls, even among older adults, makes them a useful diagnostic tool 1.
Red Flags for Spinal Cord Lesions
- Red flags for spinal cord lesions include longitudinally extensive lesions, prominent involvement of the central grey matter, swelling of the spinal cord, and leptomeningeal or nerve root involvement 1.
- These red flags can indicate alternative diagnoses, such as neuromyelitis optica spectrum disorders, anti-MOG-IgG disease, or infectious diseases, and should be carefully evaluated in the diagnostic process 1.
From the Research
Spine Location Associated with MS Lesions
The spine location associated with MS lesions causing intermittent heavy leg sensation is not directly stated in the provided studies. However, the studies provide information on the location of MS lesions in the spinal cord and their correlation with clinical parameters.
Location of MS Lesions
- The majority of plaques were peripherally located, and occupied less than 50% of the cross-sectional area of the cord 2.
- Focal lesions were seen in patients with benign form of MS, whereas secondary progressive MS patients had diffuse cervical cord abnormalities, and primary progressive MS patients exhibited both forms of changes 3.
- The mid-cervical region of the spinal cord appeared to be the commonest location of the focal lesions 3.
- The lateral funiculi were more frequently affected by lesions in progressive subtypes than in relapsing subtypes 4.
- The central cord area was more often affected by lesions in primary progressive than relapse-remitting patients 4.
Correlation with Clinical Parameters
- The presence and character of demyelinating lesions in the cervical cord are significantly related to the clinical form of the disease 3.
- Lesions located in the lateral funiculi and central cord area of the cervical spine may influence clinical status in multiple sclerosis 4.
- The association between MS and spondylosis is related to younger age, more severe disability, and extensive lesions in the brain 5.