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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

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Abstract

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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Acknowledgements

Supported in part by a grant from the National Fibromyalgia Research Association, which played no role in the design or execution of this work. We would like to thank Drs. Daniel Malone, Scott Kale, Robert Bennett, Peter Rowe and Norman Kohn for their extensive review and very constructive criticism of the manuscript and Dr. Michael Huckman for review of issues relating to radiological imaging. We would like to thank Dr. Kareem Foloshade and Ms. Melissa Martinez for meticulous data entry.

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Authors and Affiliations

  1. Heffez Neurosurgical Associates SC, 12th Floor, 2900 North Lake Shore Drive, Chicago, IL 60657, USA

    Dan S. Heffez

  2. Chicago Institute of Neurosurgery and Neuroresearch, Chicago, Illinois, USA

    Dan S. Heffez, Ruth E. Ross, Yvonne Shade-Zeldow, Konstantinos Kostas, Sagar Shah, Robert Gottschalk & Alan Shepard

  3. Rush Presbyterian St. Luke’s Medical Center, Chicago, Illinois, USA

    Dan S. Heffez, Dean A. Elias, Sue E. Leurgans & Charity G. Moore

  4. The University of South Carolina, Columbia, South Carolina, USA

    Charity G. Moore

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  1. Dan S. Heffez
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Correspondence to Dan S. Heffez.

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Heffez, D.S., Ross, R.E., Shade-Zeldow, Y. et al. 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 13, 516–523 (2004). https://doi.org/10.1007/s00586-004-0672-x

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  • DOI: https://doi.org/10.1007/s00586-004-0672-x

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