When most people hear about multiple sclerosis (MS), they think of a disease that affects the brain, causing symptoms like fatigue, vision issues, or trouble with balance.
But there’s a part of MS that often flies under the radar, even among patients and sometimes within medical conversations: the spinal cord.
What many don’t realize is that lesions in the spinal cord can be just as damaging, if not more, than those in the brain.
Spinal MS can be “silent” in terms of MRI visibility if not specifically looked for, even as it causes very real symptoms like leg weakness, difficulty walking, or bladder problems.
Spinal Cord in MS Often Overlooked
Multiple sclerosis is a chronic condition where the immune system mistakenly attacks the protective covering of nerves (called myelin). These attacks cause pockets of damage, known as lesions, that disrupt signals between the brain and body.
While the brain has traditionally received the most attention, the spinal cord is also an important component of the central nervous system.
It serves as a communication link between your brain and the rest of your body. Lesions here can affect muscle control, coordination, and even internal processes such as bladder and bowel control.
So, why are so many spinal lesions missed? One main reason is that MRI scans are typically focused on the brain, particularly during diagnostic or routine monitoring. If the spinal cord isn't scanned, these silent but impactful lesions may go undetected.
Why Spinal Symptoms Shouldn’t Be Ignored
Spinal MS can cause symptoms that are hard to ignore:
- Leg numbness or weakness
- Loss of coordination
- Bladder urgency or retention
- Sexual dysfunction
- Back pain or tingling
These signs often get attributed to ageing, injury, or stress, leading patients to see orthopaedic or urology specialists first. What’s needed, however, is a broader neurological evaluation that includes imaging of the entire central nervous system, not just the brain.
Moreover, MS relapses can be driven by new spinal lesions even when brain MRIs appear stable. Without spinal imaging, a relapse may go unrecognised, and treatment could be delayed.
Why Full-Spine MRI Scans Are Essential
To catch spinal MS in its early stages, or during relapses, neurologists now recommend updated MRI protocols that include the cervical (neck), thoracic (mid-back), and sometimes lumbar (lower back) spine. These scans are done with contrast, which helps highlight active inflammation or new lesions.
Whole-CNS imaging is particularly important:
- At the time of diagnosis - to get a complete baseline of disease activity
- When new symptoms appear, especially those related to movement or bladder
- During relapses - to identify new disease activity, even if the brain looks unchanged
Early detection leads to early treatment, which is crucial in MS. Modern therapies are most effective when started before irreversible damage sets in.
Ongoing Monitoring Beyond Brain MRIs
Even after diagnosis, patients with MS should have periodic spinal MRIs in addition to brain scans. This is especially true for individuals with lower-limb or bladder symptoms, or when relapses are suspected but not supported by brain imaging alone.
Missing spinal lesions may imply missing indicators of disease development, allowing impairment to creep in silently over time.
Don’t Ignore New Symptoms
If you have MS and notice new symptoms in your legs, back, or bladder, do not ignore them. Similarly, if your doctor tells you that your brain MRI is stable but your symptoms suggest otherwise, ask whether a spinal MRI has been done. Advocating for comprehensive imaging could make a big difference in managing your condition effectively.
And if you’re not yet diagnosed with MS but are having unexplained neurological symptoms like sudden leg weakness, numbness, or urinary changes, don’t settle for partial answers. A complete evaluation, including spinal imaging, may help uncover a diagnosis that’s been missed.
Spinal MS Needs Equal Attention
Multiple sclerosis is a complex condition, but the tools to manage it are better than ever before—if we use them fully. Spinal MS shouldn’t be treated as an afterthought.
With improved imaging, increased awareness, and proactive care, many of the complications from spinal lesions can be avoided or slowed down.
If you’re living with MS or unexplained neurological symptoms, talk to your doctor about a full CNS workup. When in doubt, visit a specialist. Sometimes, what you can’t see really does matter.
