| Cervical Spinal
Stenosis Abstract III
Decompression of Craniovertebral Stenosis Leads to Improvement in FMS
and CFIDS Symptoms
Michael J Rosner, MD, FACS, FCCM
 After observing two patients with cervical stenosis whose “chronic
fatigue syndrome” improved after surgery, we prospectively evaluated
48 patients diagnosed with chronic fatigue or fibromyalgia syndrome. We
tested the hypotheses that the spinal canal would be stenotic in patients
with chronic fatigue and fibromyalgia syndromes, and that decompression
of craniovertebral stenosis would lead to improvement in symptomatology
and objective neurologic findings. A detailed neurological history and
examination were performed on all patients pre- and post operatively.
In addition, those patients undergoing surgery were asked to complete
a questionnaire with regard to symptomatology at two time points after
surgery. Magnetic resonance scans were obtained on patients with a standardized
protocol which allowed quantification of the AP diameter of the spinal
canal, and AP and transverse spinal cord diameters at C1 through C7 levels.
The AP compression ratio and spinal cord area were calculated for each
patient. The foramen magnum was also studied and in selected patients
a Cine-MR scan was used to help evaluate a small posterior fossa or Chiari
syndrome. The level of the obex above the plane of the foremen magnum
was measured. For those patients with purely congenital cervical stenosis,
a laminectomy was carried out based upon those levels which were in the
stenotic range. If the cerebellar tonsils or foramen magnum were “tight”
or abnormalities of CSF outflow from the posterior fossa were identified,
the patient underwent suboccipital craniectomy with laminectomy of C1
and C2, usually with duraplasty. If both conditions were present the patient
underwent simultaneous posterior fossa and cervical decompression. If
purely anterior spinal cord compression was present then the patient was
treated with anterior cervical decompression and fusion. All patients
had positive findings on neurologic history suggestive of myelopathy.
Most patients were hyperreflexic and most demonstrated Babinski and other
upper motor neuron findings. Seventy to 75% of this group had sensory
and/or motor findings in the upper and lower extremities, abnormalities
of gait, and other objective changes. The average spinal canal AP diameter
in the mid-cervical region was less than 12mm from C3 through C6 and the
average spinal cord size was below the lower limits of normal. Decompression
of the cervical spinal canal lead to a statistically reliable increase
in the AP diameter, AP compression ratio and spinal cord areas. Neurologic
symptoms and signs reverted to normal or nearly normal in 60 to 65% of
the patients with nearly all the remainder demonstrating improvement of
some degree in sensory, motor, reflex, or extrapyramidal abnormalities.
Two patients felt that some of their sensory symptoms had worsened. One
felt weaker in the upper extremities and one felt their bladder had worsened.
Four patients felt they had not changed in their neurologic symptoms.
By 24 + 2.7 weeks after surgery, 80% of the patients felt improved in
most of a list of 18 symptoms. Fifteen to 20% felt that they were unchanged
with fewer than 10% feeling that they had worsened in some symptoms. By
78 + 26 weeks after surgery, the questionnaire was repeated with more
detail. Approximately 10 to 15% reported they were worse in some types
of symptomatology; 10 to 20% felt they were unchanged in some of their
symptoms with the remainder reporting some degree of improvement. More
than half felt 50% or more improved after surgery. Nearly all patients
improved in some spheres.
There is a subset of patients with the diagnosis of chronic fatigue-immunodeficiency
syndrome or fibromyalgia syndrome who suffer from some element of craniovertebral
compression. This is primarily congenital in nature and appears relatively
normal unless more highly quantified analysis of the spinal canal and
posterior fossa are carried out. Detailed neurological history and physical
findings in this group of patients are consistent with a chronic myelopathy.
The majority of the signs and symptoms can be reversed in these patients
with craniocervical decompression. This study does not provide insight
into how many patients with ID-CFS or FMS may actually suffer from craniovertebral
radiological compression. The problem is potentiated by the relative lack
of quantification of craniovertebral radiological evaluation.
New Dimensions in Fibromyalgia Symposium, Portland, Oregon, September
1997
National Fibromyalgia Research Association
PO Box 500, Salem, OR 97308
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