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Surgical Treatment of Myelopathy Relieves
Some Symptoms of Fibromyalgia

Dan S. Heffezą M.D., Sam R. Bannerą M.D., Daniel G. Malone˛ M.D., Alan Shepardą M.D. and Ruth E. Rossą Ph.D. (Sponsored by Daniel Malone) ąChicago Institute of Neurosurgery and Neuroresearch, Chicago, IL 60614 and ˛University 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.

For Appointment Information Contact:

CINN - Dan Heffez, MD

ATTENTION:   Robert Gottschalk

c/o Advocate Ravenwood Medical Center

Specialty Care Pavilion

4550 N. Winchester Ave

Chicago, IL 60640

(773) 250-0366

National Fibromyalgia Research Association
PO Box 500, Salem, OR 97302