Multiple sclerosis (MS) is a progressive neurologic disease, which usually affects
younger individuals and causes significant permanent disability. It is believed that
pathophysiology of MS possesses two arms: inflammatory demyelination and neurodegeneration
with resultant brain and spinal cord tissue atrophy due to significant tissue loss.
In the past two decades, the role of central nervous system (CNS) tissue atrophy has
been emerging as a significant marker of disability in MS patients and substantial
research efforts have been focused on the gray matter as well as white matter volume
loss in the context of the neurodegenerative arm of this progressive neurologic disease.
More neurologists and neuroimagers recognize the concept of the brain and spinal cord
atrophy and realize their compromising impact, as an independent variable, on the
quality of life and long term disability of MS patients [
- Chataway J.
- Schuerer N.
- Alsanousi A.
- et al.
Effect of high-dose simvastatin on brain atrophy and disability in secondary progressive
multiple sclerosis (MS-STAT): a randomised, placebocontrolled, phase 2 trial.
]. In particular, spinal cord atrophy has captured significant research attention.
In a longitudinal study, Stevenson et al. [
- Stevenson V.L.
- Leary S.M.
- Losseff N.A.
- Parker G.J.
- Barker G.J.
- Husmani Y.
- Miller D.H.
- Thompson A.J.
Spinal cord atrophy and disability in MS: a longitudinal study.
] evaluated progressive cervical cord atrophy in a cohort of MS patients with progressive
MS and found that during one year of follow up, the mean upper cervical cord area
showed a decrease of −3.53 mm3
in those with primary progressive MS (n
= 12) as compared to −0.26 mm3
in those with secondary progressive MS (n
= 6). Despite the small number of patients, their findings evidently illuminated
the rising concept of “cord atrophy” in MS. Another study by Agosta et al. [
- Agosta F.
- Absinta M.
- Sormani M.P.
- Ghezzi A.
- Bertolotto A.
- Montanari E.
- Comi G.
- Filippi M.
In vivo assessment of cervical cord damage in MS patients: a longitudinal diffusion
tensor MRI study.
] also measured the cervical cord injury in MS patients. The investigators measured
the cervical cord atrophy in participants with primary progressive (n
= 15), secondary progressive (14), and relapsing-remitting (n
= 13) MS. They stated that the decline in cervical cord area during a mean of 2.4 years
by 3.1 mL in patients with primary progressive MS, as compared with 2.2 mL in secondary
progressive and 5.4 mL in patients with relapsing-remitting MS. Such exploratory and
objective observations extensively highlighted the presence and progressive nature
of spinal cord atrophy during MS pathogenesis. Previously, it has also been demonstrated
that spinal cord atrophy may occur independently from brain atrophy in MS patients
- Bonati U.
- Fisniku L.K.
- Altmann D.R.
- et al.
Cervical cord and brain grey matter atrophy independently associate with long-term
- Cohen A.B.
- Neema M.
- Arora A.
- et al.
The relationships among MRI-defined spinal cord involvement, brain involvement, and
disability in multiple sclerosis.
- Kearney H.
- Rocca M.
- Valsasina P.
- et al.
Magnetic resonance imaging correlates of physical disability in relapse onset multiple
sclerosis of long disease duration.
]. Spinal cord damage and atrophy, and more specifically, the cervical cord atrophy is
frequently observed in MS patients and is associated with progressive illness course
as well as significant disability. Such advancing disability potentially comprises
the quality of life of MS patients and limits their physical capabilities.