Chiari Malformations
Abstract II
Surgical Treatment of Myelopathy Relieves
Some Symptoms of Fibromyalgia
Dan 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 53706
OBJECTIVE: An association has been suggested
between fibromyalgia and cervical myelopathy. If so, treatment of myelopathy
could relieve some symptoms of fibromyalgia.
METHODS: Twenty-two 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%).
RESULTS: 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.
CONCLUSION: 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.
Presented at the National Fibromyalgia Research Association's Subgroups
in Fibromyalgia Symposium, September 26-27, 1999, in Portland,
Oregon.
