Cervical Intervertebral Disc Displacement in Multiple Sclerosis Patients: A Possible Trigger for the Pathogenesis of Multiple Sclerosis?

摘要

Background: Few articles in the world have already correlated these two themes. The reason we wrote this paper is to suggest a pathogenic hypothesis that correlates the two diseases. Methods: We reviewed the medical literature in the MEDLINE/PubMed and LILACS/SciELO databases. We used the terms “cervical intervertebral disc displacement”, “multiple sclerosis”, “neuroinflammation”, “pathogenesis” and its combinations. Results: Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). Spinal cord myelopathy in MS presents with neck and radicular pain, segmental weakness, hypoesthesia and diminution of tendon reflexes. All of these symptoms may also appear in myelopathy due to cervical spine compression. It is observed in the context of cervical intervertebral disc displacement (CIDD). CIDD is the most common progressive disorder in the aging cervical spine. Clinical researches have described CIDD at different levels in MS patients. However, the majority of these clinical studies were only descriptive. The correlation between the two diseases and the study of the pathogenesis of them was little studied. We hypothesized an unprecedented theory for a possible pathogenic mechanism between CIDD and MS. Can the CIDD be a trigger for the onset of spinal demyelination in MS patients? Conclusions: We believe with blood-spinal cord barrier (BSCB) disruption the neutrophils invasion on CNS is facilitated. Thus local neuroinflammation on the spinal cord in patients with CIDD could be a facilitating factor for neutrophils infiltration to the CNS in MS. This cascade of neuroinflammation may be one of the triggers for the activation of demyelination in the spinal cord of MS patients.