In multiple sclerosis (MS), lesions (areas of damage) 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, spinal lesions may play a role in which MS symptoms you experience and even help doctors predict your disease progression.

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

What Causes Spinal 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 spinal lesions typically form in two main areas of the spinal cord:

• Cervical spine — About 60 percent of MS spinal lesions develop in the cervical spine (the part made up of the first seven bones of the spine).
• Thoracic spine — Lesions can form in the part of the spine that runs from the base of the neck down through your mid-back.

About 60 percent of MS spinal lesions develop in the neck or the first seven bones of the spine.

Other Conditions That Cause Spinal Lesions

Several other diseases can also cause spinal 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 virus or tuberculosis
• MOG antibody-associated disease (MOGAD)

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

What Symptoms Do MS Spinal Lesions Cause?

Spinal lesions can cause a variety of symptoms, depending on their location and how severe the nerve damage is. Here are a few of the common symptoms that appear along with spinal lesions in MS.

1. Walking Difficulties

More than 28,000 members of MyMSTeam report 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.

2. Coordination Problems

Problems with coordination can look different for everyone. More than 34,000 members have reported having trouble with balance, and more than 10,000 have experienced tremors.

More than 34,000 members of MyMSTeam have reported trouble with balance, and more than 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 MyMSTeam member.

“I have a cold, so I’m a little more uncoordinated,” wrote another.

3. Bladder Issues

More than 25,000 members of MyMSTeam 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 another member.

4. Bowel Dysfunction

Bowel problems are reported less frequently than other common symptoms of MS spinal lesions. More than 11,000 members have reported issues with their bowels. “I’m having problems with my bowels and hate it,” said one member.

Another reported, “Bladder and bowel issues need constant attention.”

Spinal MS vs. Brain MS

Not all MS lesions cause noticeable symptoms. Compared with brain lesions, spinal cord lesions are more likely to cause symptoms. This is because the spinal cord isn’t as good at compensating for damage as the brain is. Symptoms are also more likely to continue after relapses (also known as flare-ups), which are periods of active or worsening symptoms.

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. You don’t need to have brain lesions to be diagnosed with MS. A diagnosis can still be made if other signs are present, based on the newest diagnostic criteria.

Detecting MS Spinal Lesions

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

Spinal Lesions and MS Progression

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

For some people, signs of MS show up on MRI even though they don’t have any symptoms of MS yet. This is called radiologically isolated syndrome (RIS). A 2016 study found that silent spinal cord lesions were more frequent in people who later developed a subgroup of MS called primary progressive MS.

Among people with clinically isolated syndrome, those with spinal lesions (especially multiple spinal 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 spinal lesions are more likely to:

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

Learn more about switching MS treatments.

Preventing New or Worsening MS Lesions

Although 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 DMTs that can slow the disease progression of MS by reducing both the number of relapses and how severe they are.

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

Other MS medications are designed to ease 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 becoming more and more effective at reducing new brain lesions and possible relapses. These medicines are better at controlling disease activity compared to standard DMTs. However, the study did not find enough evidence that high-efficacy DMTs reduce new spinal cord lesions. More clinical trials are needed to learn how DMTs affect new spinal cord lesions.

Work with your neurology team to find a treatment plan you can stick to. 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 time to talk to your doctor about switching treatments.

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 if current lesions have changed, so they can make adjustments to your treatment plan if needed.

Talk With Your Doctor

Understanding spinal lesions can help people with MS and their healthcare teams manage symptoms more effectively. Spinal lesions play a role in many MS symptoms, and regular monitoring with MRI scans can track changes in your disease course over time. By keeping an eye on spinal health, doctors can make recommendations about treatment options as needed.

DMTs can help reduce relapses and slow down MS progression. Working closely with a neurology team can help you take steps toward maintaining your quality of life while living with MS.

Join the Conversation

On MyMSTeam, people share their experiences with MS, get advice, and find support from others who understand.

Do you have spinal lesions from MS? What symptoms do you have? Let others know in the comments below.