Cervical Spinal Stenosis
Cervical Spinal
Stenosis Abstract I
Can Spinal Cord Compression Cause the Fibromyalgia Syndrome?
Dan S. Heffez¹ M.D., Daniel G. Malone² M.D., Sam R. Banner¹
M.D., Alan Shepard¹ M.D., Ruth E. Ross¹ Ph.D. and James W. Robertson¹
B.S. (Sponsored by Daniel Malone)¹ Chicago Institute of Neurosurgery
and Neuroresearch, Chicago, IL 60614 and ²University of Wisconsin
at Madison, Madison, WI 53706
OBJECTIVE: The symptoms of cervical myelopathy
mimic those of fibromyalgia. We established a prospective database to
catalogue neurological findings in patients with fibromyalgia to examine
the possible etiological role of spinal cord compression. The principal
criterion for referral is cervical spinal canal or foramen magnum stenosis
on a screening MRI scan. Patients complete a detailed questionnaire regarding
current symptoms and past medical care and are examined by a neurologist
and a neurosurgeon. Measures of balance, strength, coordination, and cognitive
function are obtained using a battery of standardized tests.
METHODS: To date, forty-five consecutive fibromyalgia
patients (87% female, median age 44 years, median duration of illness
6 years) have been evaluated for myelopathy. Neurological symptoms included
fatigue (93%), fatigue upon exertion (98%), cognitive impairment (96%),
diffuse pain (93%), headache (89%), weakness (89%), impaired balance (80%),
paresthesiae (82%), clumsiness (71%), numbness (73%), dizziness (62%),
and diplopia (71%). Neurological signs included hyperreflexia (80%), spinothalamic
sensory level (79%), recruit of reflexes (44%), impaired tandem walk (32%),
positive Romberg sign (31%), clonus (28%), Hoffman sign (26%), dysdiadokokinesia
(28%), impaired position sense (19%) and dysmetria (19%). Only 3 patients
had a normal neurological examination. Detailed MRI imaging of the cervical
spine and foramen magnum revealed cervical stenosis (n=21), brainstem
compression due to tonsillar ectopia (n=12) or, both cervical stenosis
and tonsillar ectopia (n=11).
CONCLUSION: We conclude that some patients with
fibromyalgia have cervical myelopathy on the basis of spinal cord or cervicomedullary
compression. We recommend a thorough neurological examination and a screening
MRI scan of the cervical spine and brain in all patients with fibromyalgia
who do not respond to conventional medical therapy.
Presented at the National Fibromyalgia Research Association's Subgroups
in Fibromyalgia Symposium, September 26-27, 1999, in Portland,
Oregon.
