Treatment of Myelopathy Relieves
Some Symptoms of Fibromyalgia
S. Heffez¹ M.D., Sam R. Banner¹ M.D., Daniel G. Malone² M.D., Alan Shepard¹
M.D. and Ruth E. Ross¹ Ph.D. (Sponsored
by Daniel Malone) ¹Chicago Institute of Neurosurgery and Neuroresearch,
Chicago, IL 60614 and ²University of Wisconsin at Madison, Madison, WI
OBJECTIVE: An association
has been suggested between fibromyalgia and cervical myelopathy.
If so, treatment of myelopathy could relieve some symptoms of fibromyalgia.
fibromyalgia patients with cervical myelopathy (82% female, mean duration
of illness 6.1 years +/-4.49) were evaluated.
Symptoms included fatigue (100%), cognitive impairment (100%),
exertion intolerance (95%), diffuse pain (86%), headache (86%), clumsiness
and instability (91%), nonrestorative sleep (82%), nausea (64%), dizziness
(59%) and numbness (59%). Neurological
signs included hyperreflexia (86%), recruitment of reflexes (46%), impaired
tandem walk (41%), positive Romberg sign (37%), spinothalamic sensory
level (32%), nystagmus (27%) and appendicular ataxia (23%).
MRI imaging revealed foramen magnum stenosis due to cerebellar
tonsillar herniation (n=8), cervical spinal stenosis (n=7) or both (n=7). Surgical decompression of the foramen magnum (n=13), the cervical
spinal canal (n=7) or both (n=2) was performed. After a minimum 6-month follow-up, (range: 0.5-2.5 years), 81% of
patients reported sustained improvement in the distribution and intensity
of pain. Cognitive dysfunction
(75%), dizziness (77%), numbness (77%), fatigue (70%), headache (68%),
nausea (65%), capacity for exertion (65%) and quality of sleep (50%) also
improved. Improved performance
on neurological examinations was noted.
We conclude that fibromyalgia patients with myelopathy can experience
an improvement in symptoms of fibromyalgia following surgical decompression
of the cervical spine or foramen magnum.
We have developed a database to identify any etiological link between
cervical myelopathy and fibromyalgia.
at the National Fibromyalgia Research Association's Subgroups in Fibromyalgia
Symposium, September 26-27, 1999, in Portland, Oregon.
Appointment Information Contact:
Dan Heffez, MD
Milwaukee Neurological Institute
2350 W. Villard Ave