This study aims to compare the clinical features and disability profiles at onset and follow-up in patients with vascular myelopathy (VM) versus inflammatory myelopathy (IM), and identify factors associated with poor functional outcomes.

The clinical, laboratory and imaging features of 80 patients with VM and 149 patients with IM referred and followed in a specialized clinic between 2010 and 2018 were analyzed and compared between categories. The functional status was evaluated at onset and follow-up by using the modified Rankin scale (mRs) and compared between the two categories. A multivariate logistic regression model was performed to identify factors associated with poor outcome (mRs>3). 

The VM group had worse mRs scores compared to the IM group at onset and follow up assessment (p value 0.001 for the 2 time points). Importantly, both groups demonstrated improvement in disability from onset to follow up, with the VM reaching a mRs score of 3 and the IM an score 2 after 7 months. The factors associated with worst outcome (mRs>3) included VM as diagnostic category and longitudinally extensive lesion in the MRI.

Recognition of VM is critical step in management as the clinical features, management and prognosis are different from IM. Overall, VM have worse functional outcomes compared to IM but both vascular and inflammatory myelopathy have potential for recovery over time.