Association between cervical spinal cord plaque length and adjacent degenerative cervical changes in multiple sclerosis: a cross-sectional MRI study.

OBJECTIVE

To evaluate the association between cervical spinal cord demyelinating plaque length and adjacent degenerative cervical changes in patients with multiple sclerosis (MS).

METHODS

This cross-sectional study included 130 consecutive adult patients with confirmed MS who underwent cervical spine MRI at a tertiary referral center (2019-2022). Maximum plaque length was measured on T2-weighted sequences. Cervical spondylosis severity was graded using five validated systems: modified Pfirrmann grading (disc degeneration), Modic classification (vertebral endplate changes), Matsumoto grading (posterior disc protrusion), Kang classification (central canal stenosis), and Park grading (foraminal stenosis). Spatial co-localization of plaques and degenerative changes was assessed at each cervical level. Multivariable linear and logistic regression and Spearman correlation were performed were used to evaluate associations.

RESULTS

Degenerative cervical changes were present in 92.3% of patients (mean age 36.2 ± 10.1 years; 72.3% female). Mean plaque length was 8.2 ± 3.4 mm. Plaque length was positively associated with degenerative severity (Spearman r = 0.51, p < 0.001). Each 1-mm increase in plaque length was associated with a 0.52-grade higher Pfirrmann score (β = 0.52, 95% CI 0.38-0.66; p < 0.001) and higher odds of Modic changes (OR = 2.12, 95% CI 1.76-2.55; p < 0.001). At the cervical-level analysis, plaque presence was associated with higher odds of degenerative change at the same level (OR = 3.4, 95% CI 2.5-4.6; p < 0.001).

CONCLUSION

Larger cervical demyelinating plaques were associated with more severe adjacent degenerative changes and greater same-level co-occurrence. Further longitudinal studies are warranted to determine the prognostic significance of cervical plaque characteristics.