Loss of nerves in spinal cord leads to more disability

Epub: Lukas et al. Relevance of Spinal Cord Abnormalities to Clinical Disability in Multiple Sclerosis: MR Imaging Findings in a Large Cohort of Patients. Radiology. 2013 Jun 4. 

Purpose:To determine whether spinal cord atrophy differs among disease subtypes in multiple sclerosis (MS) and whether it offers diagnostic and clinical correlative information beyond that provided by other magnetic resonance (MR) imaging markers.

Materials and Methods:Upper cervical cord cross-sectional area (UCCA), brain and spinal cord lesion loads, and brain atrophy were measured in 440 patients with MS (311 with relapsing-remitting [RR] MS, 92 with secondary-progressive [SP] MS, and 37 with primary-progressive [PP] MS) studied in two centres. Disability was scored with the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (TWT), and the nine-hole peg test. 

Results: The UCCA in patients with SP MS (median, 79 mm2; interquartile range, 72.4-84.9 mm2) and PP MS (median, 77.3 mm2; interquartile range, 69-82.5 mm2) was significantly smaller (P < .001) than that in patients with RR MS (median, 84 mm2; interquartile range, 78.7-89.3 mm2). UCCA was inversely correlated with EDSS score, TWT, and nine-hole peg test findings (ρ ≤ -0.29, P < .001 for all comparisons). UCCA, number of hypointense brain lesions on T1-weighted MR images, presence of diffuse abnormalities, and number of involved segments in the spinal cord were found to be significant explanatory factors for clinical disability (R2 = 0.564). The UCCA and the number of hypointense brain lesions on T1-weighted images were the strongest MR imaging parameters for explaining physical disability, as measured with the EDSS.

Conclusion: Spinal cord abnormalities have a strong effect on clinical disability in MS. MR imaging-derived UCCA was found to be the most significant spinal cord parameter for explaining EDSS score.

Progressive MSers (PP and SP) had smaller spinal cords, probably due to nerve loss) and the lower the size of the spinal cord near the neck (cervical) the higher was the mobility disability in the form of EDSS and functional activity such as putting pegs in holes. MRI measures when present indivate that the more features you have in your spinal cord then themore likely you are to have problems with EDSS. So this study is further telling us some thing that we already  know that problems in the spinal cord are bad for mobility.

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