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01-09-2007 | Original Article

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

Authors: Dan S. Heffez, Ruth E. Ross, Yvonne Shade-Zeldow, Konstantinos Kostas, Mary Morrissey, Dean A. Elias, Alan Shepard

Published in: European Spine Journal | Issue 9/2007

Abstract

Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients’ quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P ≤ 0.018–0.001, Chi-square or Fisher’s exact test). At the 1 year follow-up, there was a statistically significant improvement in both physical and mental quality of life as measured by the SF-36 score for the surgical group as compared to the non-surgical group (Repeated Measures ANOVA P < 0.01). There was a statistically significant improvement in the scores from Scale 1 of the MMPI-2 and the screening test for somatization disorder, and the anxiety and depression scores exclusively in the surgical patients (Wilcoxon signed rank, P < 0.001). The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life. We recommend detailed neurological and neuroradiological evaluation of patients with fibromyalgia in order to exclude compressive cervical myelopathy, a potentially treatable condition.

An HS (1998) Clinical presentation of discogenic neck pain, radiculopathy and myelopathy. In: The Cervical Spine Research Society editorial committee. The cervical spine, 3rd edn. Lippincott-Raven, Philadelphia, pp 755–764

Arroyo JF, Cohen ML (1993) Abnormal response to electrocutaneous stimulation in fibromyalgia. J Rheumatol 20:1925–1931PubMed

Barkovich AJ, Wippold FJ, Sherman JL et al (1986) Significance of cerebellar tonsillar position on MR. AJNR 7:795–799PubMed

Barsky AJ, Borus JF (1999) Functional somatic syndromes. Ann Intern Med 130:910–921PubMed

Bendtsen L, Norregaard J, Jensen R et al (1997) Evidence of qualitatively altered nociception in patients with fibromyalgia. Arthritis Rheum 40:98–102PubMedCrossRef

Bennett RM, Fibromyalgia (1999) In: Wall PD, Melzack R (eds) Textbook of pain, 4th edn. Churchill Livingstone, Edinburgh, pp 579–599

Blumberg KD, Simeone FA (1992) Indications for surgery in cervical myelopathy: anterior versus posterior approach. In: Rothman RH, Simeone FA (eds) The spine, 3rd edn. WB Saunders, Philadelphia, pp 613–625

Brain RW, Northfield D, Wilkinson M (1952) The neurological manifestations of cervical spondylosis. Brain 75:187–225PubMedCrossRef

Buchwald D (1996) Fibromyalgia and chronic fatigue syndrome: similarities and differences. Rheum Dis Clin North Am 22:219–243PubMedCrossRef

10.

Butcher JN (1990) MMPI-2 in psychological treatment. Oxford University Press, New York

11.

Clarke E, Robinson PK (1956) Cervical myelopathy: a complication of cervical spondylosis. Brain 79:483–510PubMedCrossRef

12.

Crandall PH, Batzdorf U (1966) Cervical spondylotic myelopathy. J Neurosurg 25:57–66PubMed

13.

Dillin WH, Watkins RG (1992) Clinical syndromes of cervical myelopathy. In: Rothman RH, Simeone FA (eds) The spine, 3rd edn. WB Saunders, Philadelphia, pp 560–570

14.

Forseth KO, Forre O, Gran JT (1999) A 5.5 year prospective study of self-reported musculoskeletal pain and of fibromyalgia in a female population: significance and natural history. Clin Rheumatol 18:114–121PubMedCrossRef

15.

Giovengo SL, Russell IJ, Larson AA (1999) Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with fibromyalgia. J Rheumatol 26:1564–1569PubMed

16.

Goldenberg DL (1996) What is the future of fibromyalgia? Rheum Dis Clin North Am 22:393–406PubMedCrossRef

17.

Heffez DS, Ross RE, Shade-Zeldow Y et al (2004) 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 13:516–523PubMedCrossRef

18.

Herrmann C (1997) International experiences with the HADS—a review of validation data and clinical results. J Psychosom Res 42:17–41PubMedCrossRef

19.

Herzog RJ, Wiens JJ, Dillingham MF et al (1991) Normal cervical spine morphometry and cervical spinal stenosis in asymptomatic professional football players. Plain film radiography, multiplanar computed tomography and magnetic resonance imaging. Spine 16:s178–s186

20.

Jahnke RW, Hart BL (1991) Cervical stenosis, spondylosis and herniated disc disease. RCNA 29:777–791

21.

Kaiser JA, Holland BA (1998) Imaging of the cervical spine. Spine 3:2701–2712CrossRef

22.

King JT Jr, Roberts MS (2002) Validity and reliability of the short form-36 in cervical spondylotic myelopathy. J Neurosurg 97(2 suppl):180–185

23.

Kosek E, Ekholm J, Hansson P (1996) Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 68:375–383PubMedCrossRef

24.

Kwiatek R, Barnden L, Tedman R et al (2000) Regional cerebral blood flow in fibromyalgia: single photon-emission computed tomography evidence of reduction in the pontine tegmentum and thalami. Arthritis Rheum 43:2823–2833PubMedCrossRef

25.

Lautenbacher S, Rollman GB (1997) Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain 13:189–196PubMedCrossRef

26.

Lees F, Turner JWA (1963) Natural history and prognosis of cervical spondylosis. Br Med J 2:1607–1610PubMedCrossRef

27.

Matsuura P, Waters RL, Adkins RH et al (1989) Comparison of computerized tomography parameters of the cervical spine in normal control subjects and spinal cord injured patients. JBJS 71:183–188

28.

Mense S (2000) Neurobiological concepts of fibromyalgia—the possible role of descending spinal tracts. Scand J Rheumatol Suppl 113:24–29PubMedCrossRef

29.

Milhorat TH, Chou MW, Trinidad EM et al (1999) Chiari 1 malformation redefined: clinical and radiological findings in 364 symptomatic patients. Neurosurgery 44:1005–1017PubMedCrossRef

30.

Mountz JM, Bradley LA, Modell JG et al (1995) Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and caudate nucleus are associated with low pain threshold levels. Arthritis Rheum 38:926–938PubMedCrossRef

31.

Muhle C, Wiskirchen J, Weinert D et al (1998) Biomechanical aspects of the subarachnoid space and cervical cord in healthy individuals examined with kinematic magnetic resonance imaging. Spine 23:556–567PubMedCrossRef

32.

Muhle C, Metzner J, Weinert D et al (1999) Kinematic MR imaging in surgical management of cervical disc disease, spondylosis and spondylotic myelopathy. Acta Radiol 40:146–153PubMedCrossRef

33.

Othmer E, DeSouza C (1985) A screening test for somatization disorder (hysteria). Am J Psychiatry 142:1146–1149PubMed

34.

Parke WW (1988) Correlative anatomy of cervical spondylotic myelopathy. Spine 13:831–837PubMedCrossRef

35.

Reul J, Gievers B, Weis J et al (1995) Assessment of the narrow cervical spinal canal: a prospective comparison of MRI, myelography and CT-myelography. Neuroradiology 37:187–191PubMed

36.

Russell IJ, Orr MD, Littman B et al (1994) elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum 37:1593–1601PubMedCrossRef

37.

Russel EJ (1995) Computed tomography and myelography in the evaluation of cervical degenerative disease. Neuroimaging Clin N Am 5:329–348

38.

Sampath P, Bendebba M, Davis JD et al (2000) Outcome of patients treated for cervical myelopathy. Spine 25:670–676PubMedCrossRef

39.

Stanley JH, Schabel SI, Frey GD et al (1986) Quantitative analysis of the cervical spinal canal by computed tomography. Neuroradiology 28:139–143PubMedCrossRef

40.

Thimineur M, Kitaj M, Kravitz E et al (2002) Functional abnormalities of the cervical cord and lower medulla and their effect on pain:observations in chronic pain patients with incidental mild Chiari 1 malformation and moderate to severe cervical cord compression. Clin J Pain 18:171–179PubMedCrossRef

41.

Ulrich CG (1998) Computed tomography and myelography of the cervical spine. In: Cervical Spine Research Society editorial committee. The cervical spine, 3rd edn. Lippincott-Raven, Philadelphia, pp 253–270

42.

Vaeroy H, Helle R, Forre O et al (1988) Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis. Pain 32:21–26PubMedCrossRef

43.

Wallace DJ (1997) The fibromyalgia syndrome. Ann Med 29:9–21PubMed

44.

Ware JE, Kasinski M, Keller SD (1994) SF-36 physical and mental health summary scales: a user’s manual. The Health Institute, Boston

45.

Wolfe F, Smythe HA, Yunus MB et al (1990) The American College of Rheumatology, 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172PubMedCrossRef

46.

Wolfe F, Ross K, Anderson J (1995) The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 38:19–28PubMedCrossRef

47.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef

Title: Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications
Authors: Dan S. Heffez
Ruth E. Ross
Yvonne Shade-Zeldow
Konstantinos Kostas
Mary Morrissey
Dean A. Elias
Alan Shepard
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 9/2007
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-007-0366-2

At a glance: The STEP trials

Springer Medicine

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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