What is the impact of spinal lesion placement on the body in Multiple Sclerosis (MS)?

From the Guidelines

Spinal lesion placement in Multiple Sclerosis (MS) has a significant impact on the body, with lesions often small, covering less than two vertebral segments, and usually less than half of the cord area.

Characteristics of Spinal Cord Lesions

• Lesions are typically focal, with clearly demarcated borders, and can be cigar-shaped on sagittal images, and wedge-shaped on axial images 1
• Lesions are often located in the periphery of the spinal cord, mainly in the lateral or dorsal columns, but can also affect the anterior white matter and the central grey matter 1
• T1 hypointensity is frequently observed in MS cord lesions, especially when imaged with higher field strengths or when PSIR sequences are acquired 1

Diagnostic Criteria

• Spinal cord lesions can contribute to both dissemination in space (DIS) and dissemination in time (DIT), and are an important factor in the diagnosis of MS 1
• The presence of one spinal cord lesion identifies patients at higher risk of MS confirmation 1
• Whole spinal cord MRI is recommended to meet DIS criteria, whereas it has a limited role for DIT 1

Red Flags

• Longitudinally extensive lesions extending over three or more vertebral segments are considered a red flag, as well as prominent involvement of the central grey matter, swelling of the spinal cord, leptomeningeal or nerve root involvement, cavitation, and evidence of micro/macrobleeds 1

Clinical Implications

• Spinal cord lesions are not seen with normal ageing or in the majority of common neurological disorders, such as migraine and cerebrovascular diseases 1
• The presence of asymptomatic spinal cord lesions in patients with brain MRI findings that are suggestive of radiologically isolated syndrome (RIS) heralds an increased risk of short-term progression to either clinically isolated syndrome (CIS) or primary progressive MS 1

From the Research

Impact of Spinal Lesion Placement on the Body in Multiple Sclerosis (MS)

The placement of spinal lesions in Multiple Sclerosis (MS) patients has been found to have a significant impact on the body. Studies have shown that:

• Lesions located in the lateral funiculi and central cord area of the cervical spine may influence clinical status in MS 2
• The proportion of patients with focal lesions involving at least two white matter columns and extending to grey matter was higher in secondary progressive MS than in relapsing-remitting MS 3
• Lesions in the corticospinal tracts from the cortex to the cervical spinal cord are associated with disability in MS patients, with a cumulative effect of lesions along the brain, brainstem, and spinal cord portions 4

Lesion Location and Disability

Research has found that:

• Lesions in the lateral funiculi and central cord area are significantly correlated with Expanded Disability Status Scale score 2
• The number of lesions per patient involving both the lateral column and extending to grey matter is independently associated with disability 3
• Baseline spinal cord corticospinal tracts lesion volume fraction is associated with disability progression at 2-year follow-up 4

Spinal Cord Atrophy and Quality of Life

Studies have also investigated the relationship between spinal cord atrophy and quality of life in MS patients, finding that:

• Cervical spinal cord volume is independently associated with impaired upper extremity-related quality of life in patients with MS 5
• Upper cervical spinal cord area shows an inverse relationship with age, disease duration, and nine-hole peg test 5

Pediatric MS and Spinal Cord Lesions

In pediatric MS patients, research has found that:

• Spinal cord lesions are radiographically similar to those in adult-onset MS, but children with relapsing-remitting MS can also develop longitudinally extensive lesions 6
• The presence of spinal cord lesions in the first few years of disease did not correlate with physical disability in pediatric MS patients 6