Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia.

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Clinical evidence for cervical myelopathy due to Chiari malformation and

spinal stenosis in a non-randomized group of patients with the diagnosis of

fibromyalgia.

Eur Spine J. 2004 Apr 9 [Epub ahead of print]

Heffez DS, Ross RE, Shade-Zeldow Y, Kostas K, Shah S, Gottschalk R, Elias

DA, Shepard A, Leurgans SE, CG.

Heffez Neurosurgical Associates SC, 12th Floor, 2900 North Lake Shore

Drive, IL 60657, Chicago, USA.

PMID: 15083352

OBJECTIVE. While patients with fibromyalgia report symptoms consistent with

cervical myelopathy, a detailed neurological evaluation is not routine. We

sought to determine if patients with fibromyalgia manifest objective

neurological signs of cervical myelopathy.

METHODS. Two hundred and seventy patients, 18 years and older, who carried

the diagnosis of fibromyalgia but who had no previously recognized

neurological disease underwent detailed clinical neurological and

neuroradiological evaluation for the prevalence of objective evidence of

cervical myelopathy and radiological evidence of cerebellar tonsillar

herniation (Chiari 1 malformation) or cervical spinal canal stenosis.

RESULTS. Patients were primarily women (87%), of mean age 44 years, who had

been symptomatic for 8 years (standard deviation, 6.3 years). The

predominant complaints were neck/back pain (95%), fatigue (95%), exertional

fatigue (96%), cognitive impairment (92%), instability of gait (85%), grip

weakness (83%), paresthesiae (80%), dizziness (71%) and numbness (69%).

Eighty-eight percent of patients reported worsening symptoms with neck

extension. The neurological examination was consistent with cervical

myelopathy: upper thoracic spinothalamic sensory level (83%), hyperreflexia

(64%), inversion of the radial periosteal reflex (57%), positive Romberg

sign (28%), ankle clonus (25%), positive Hoffman sign (26%), impaired

tandem walk (23%), dysmetria (15%) and dysdiadochokinesia (13%). MRI and

contrast-enhanced CT imaging of the cervical spine revealed stenosis. The

mean antero-posterior (AP) spinal canal diameter at C2/3, C3/4, C4/5, C5/6,

C6/7 and C7/T1 was 13.5 mm, 11.8 mm, 11.5 mm, 10.4 mm, 11.3 mm and 14.5 mm

respectively, (CT images). In 46% of patients, the AP spinal diameter at

C5/6 measured 10 mm, or less, with the neck positioned in mild extension,

i.e., clinically significant spinal canal stenosis. MRI of the brain

revealed tonsillar ectopia >5 mm in 20% of patients (mean=7.1+/-1.8 mm),

i.e., Chiari 1 malformation.

CONCLUSION. Our findings indicate that some patients who carry the

diagnosis of fibromyalgia have both signs and symptoms consistent with

cervical myelopathy, most likely resulting from spinal cord compression. We

recommend detailed neurological evaluation of patients with fibromyalgia in

order to exclude cervical myelopathy, a potentially treatable condition.

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