In multiple sclerosis (MS), lesions develop in the central nervous system (CNS), which includes the brain and spinal cord. As many as 80 percent of people with MS develop spinal cord lesions. Depending on where they form, spine lesions may play a role in which MS symptoms you experience and even help doctors better predict your disease progression.

In this article, we’ll explore how MS causes spine lesions, which symptoms they’re associated with, and why monitoring them can be an important part of managing your MS.

What Causes Spine Lesions in MS?

In MS, the immune system mistakenly attacks the myelin sheath, the protective coating on the outside of nerve cells in the brain and spinal cord. This damage leaves behind scar tissue that forms into lesions called plaques.

MS spine lesions typically form in two main areas of the spinal cord:

• Cervical spine — About 60 percent of MS spine lesions develop in the neck or first seven bones of the spine
• Thoracic spine — From the base of the neck down through the mid-back

Other Conditions That Cause Spine Lesions

Several other diseases can also cause spine lesions similar to those seen in MS. This can make diagnosis difficult. Some diseases that can cause lesions or damage in the spine include:

• Neuromyelitis optica
• Acute transverse myelitis
• Lupus
• Infections such as Zika or tuberculosis

Doctors use a process called differential diagnosis to rule out other diseases before diagnosing MS. This means they check for and eliminate other possible causes of your symptoms to make sure MS is the correct diagnosis.

What Symptoms Do MS Spine Lesions Cause?

Spine lesions can cause a variety of symptoms, depending on their location and the severity of the nerve damage. Here are a few of the common symptoms often connected with spine lesions in MS.

Spinal cord lesions are often linked to symptoms like walking and coordination problems, as well as bladder and bowel issues.

Walking Difficulties

More than 25,000 members of MyMSTeam report experiencing walking difficulties. “Some days, walking, standing, or even sitting is a chore,” wrote one member. “When I walk with my cane and see people who are walking and looking at stuff on their phones with ease, I get envious,” said another.

Coordination Problems

Problems with coordination can take many forms. More than 32,000 members have reported trouble with balance, and over 10,000 have experienced tremors. Like other MS symptoms, coordination may get worse due to hot weather, infections, or other triggers. “Temperature changes make me fall and be uncoordinated, or I can’t think,” shared one member. “I have a cold, so I’m a little more uncoordinated,” wrote another.

Bladder Issues

More than 23,000 members have reported a range of bladder problems, another common symptom of MS. Some report incontinence: “We can all ‘leak,’” said one member. “I’m unable to empty my bladder,” replied another. “Full bladder and can’t relax enough to pee,” shared someone else.

Bowel Dysfunction

Bowel problems are reported less frequently than other common symptoms of MS spine lesions. More than 11,000 members have reported issues with their bowels. “I’m having problems with my bowels and hate it,” stated a member. Another reported, “Bladder and bowel issues need constant attention.”

Spinal MS vs. Brain MS

Not all MS lesions cause detectable symptoms. Compared with brain lesions, spinal cord lesions are more likely to cause symptoms. Those symptoms are also more likely to linger after relapses because the spinal cord isn’t as good at compensating for damage as the brain is.

Symptoms associated with spine lesions are more likely to linger than those associated with brain lesions.

Some MyMSTeam members have asked, “Can you have MS lesions on the spine but not the brain?” The short answer is yes, it’s possible. However, MS can’t be diagnosed if just the spinal cord is affected, so you’ll need follow-ups with your doctor to see how these lesions develop.

Detecting MS Spine Lesions

The most common method for detecting MS lesions is through MRI. Recent advancements in MRI techniques have allowed for higher-resolution scans that better detect small lesions in the spinal cord. Your doctor may recommend injecting gadolinium to help identify active and inflamed lesions from immune system attacks.

Spine Lesions and MS Progression

Lesions on the spinal cord can tell doctors a lot about how your condition may progress over time.

Some people have signs of MS visible on MRI but no symptoms of MS yet. Among those with spine lesions are:

• 64 percent of people later diagnosed with clinically isolated syndrome (CIS) or relapsing-remitting MS
• 100 percent of people later diagnosed with primary progressive MS

Having spine lesions may indicate MS is more likely to progress. You may also need to switch to more effective MS treatment.

Among people with CIS, those who have spine lesions (and especially multiple spine lesions) are more likely to get a diagnosis of MS and more likely to develop a disability.

In people already diagnosed with MS, those with spine lesions are more likely to:

• Have MS relapses
• Develop disability
• Need to switch disease-modifying treatments (DMTs) to more effective options

Learn more about switching MS treatments.

Preventing New or Worsening MS Lesions

While there’s no cure for MS, several strategies can help prevent new lesions or slow their progression.

Disease-Modifying Therapies

The U.S. Food and Drug Administration (FDA) has approved more than 20 disease-modifying therapies (DMTs) that can slow the disease progression of MS by reducing both the number and severity of relapses.

Other MS medications are geared toward easing symptoms instead of stopping the progression of the disease. DMTs work in a few different ways, including:

• Reducing the amounts of certain immune cells involved in MS attacks
• Regulating immune cell function
• Reducing inflammation and demyelination

A 2024 study found that high-efficacy DMTs are increasingly effective in reducing new brain lesions and possible relapses. However, the study did not find enough evidence that high-efficacy DMTs reduce new spinal cord lesions. Further research into DMT effects on new spinal cord lesions is needed.

Work with your neurology team to find a treatment plan you can stick with. That may include DMTs to slow progression and other medications to manage MS symptoms. If you’re still experiencing relapses or worsening MS symptoms despite taking a DMT, it may be a sign it’s time to talk to your doctor about switching.

Regular Monitoring

Regular MRI scans of the brain and spine can help track lesion progression and guide your treatment plan. This ongoing monitoring lets doctors see if any new lesions have formed or current ones have changed, so they can make adjustments to best support your health.

Talk With Your Doctor

Understanding spinal lesions can help people with MS and their health care teams manage symptoms more effectively. Spinal lesions play a role in many MS symptoms, and regular monitoring with MRIs can track changes over time. By keeping an eye on spinal health, doctors can make adjustments to treatment plans as needed. DMTs can help reduce relapses and slow down MS progression. Working closely with a neurology team can help those with MS take steps toward maintaining their quality of life.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 216,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you have spine lesions from MS? What symptoms do you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.