Chiari Malformations Abstract IV

Pain Syndromes and C-Spine/Foramen Magnum Cord Compression
Two-Year Experience of a University-Based Rheumatologist

Daniel G. Malone, M.D., University of Wisconsin, Madison, WI

At the September 1997 seminar sponsored by the National Fibromyalgia Research Association, I learned of the connection between fibromyalgia/CFIDS/chronic pain, and cervical spine/foramen magnum compression abnormalities. Since that time I have done thorough neurological examinations on nearly all patients referred to me with chronic pain.

Total patients seen with pain syndromes = 335, and those evaluated neurologically = 271. Of the 271, neurological abnormalities resulted in 144 recommendations for C-spine MRI, done according to a special protocol to assess true canal diameter at each cervical level. Axial cuts were made through the foramen magnum in a plane parallel to the foramen magnum to assess true cerebellar tonsillar ectopia. Eighty-eight such MRIs were done. Almost all were interpreted by the UW radiology staff as normal, as showing only minimal disc bulging, as showing DDD/DJD, or mild thecal sac effacement. Only one was read as showing a Chiari malformation, and 7 as showing frank stenosis of a moderate or severe degree. In contrast, 79 of these MRIs were interpreted by the author and by Dr. Dan S. Heffez: 12 – normal, 16 – minimal abnormality, 18 – significant cerebellar tonsillar ectopia, 21 – significant stenosis, and 24 – stenosis and ectopia. Thirty-nine patients were seen and evaluated by Dr. Heffez. Twenty-three had at least one operative procedure done, and three were not considered surgical candidates. Of the remaining 13, surgery was recommended for 11, and follow-up with possible surgery for 2.

Presented at the National Fibromyalgia Research Association's Subgroups in Fibromyalgia Symposium, September 26-27, 1999, in Portland, Oregon.