Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of Fibromyalgia
Some physicians view fibromyalgia as a somatization disorder because of these numerous and apparently unrelated complaints, and because it fails to fit the biomedical cause-effect model.
Prevalence of fibromyalgia is estimated at 2% of the general population, 3.4% of women and 0.5% of men (approximately 6 million Americans)
Many of the symptoms reported by fibromyalgia patients are identical to those reported by patients diagnosed with either Chiari 1 malformation or with cervical myelopathy due to spinal stenosis. The authors therefore evaluated a cohort of pts with fibromyalgia for objective evidence of cervical myelopathy
270 consecutive pts w/ diagnosis of fibromyalgia (from either PCP or rheumatologist) were evaluated b/w 1998-2001. The pts had no previous neurological or neuroradiological investigation. No pt had been previously diagnosed with cervical myelopathy
Every pt underwent MRI scanning of the brain and c-spine as well as CT w/ contrast of the c-spine in neutral as well as in extension. Cervical extension is known to decrease the A-P diameter of the spinal canal.
86% of the 270 pts were female, mean age was 44, average duration of sx was 8 years, 59% of pts reported antecedent craniospinal trauma 3-6 mos prior to onset of sx (from whiplash to benign blunt force trauma w/o signs of head or neck fracture/dislocation), and pts had seen on average 10 different HCPs due to their condition.
Predominant symptoms: neck/back pain (95%), fatigue (95%), exertional fatigue (96%), cognitive impairment (92%), instability of gait (85%), subjective grip weakness (83%), paresthesias (80%), dizziness (71%) and numbness of the hands/feet (69%). Eighty-eight percent of patients reported worsening symptoms with neck extension
An upper-thoracic spinothalamic sensory level (T3–T6) was the most prevalent finding, noted in 83% of patients. Most notable was hyperalgesia and allodynia to a cold or lightly applied pinprick stimulus below a dermatome level.
The second most common neurological finding, (noted in 64% of patients), was hyperreflexia, often asymmetrical in distribution and involving any combination of limbs, including inverted supinator reflex (57% of pts). Other findings included positive Romberg sign (28%), varying degrees of ankle clonus (25%), positive Hoffman sign (26%), impaired tandem walk (23%), dysmetria (15%) and dysdiadochokinesia (13%)
The AP mid-sagittal diameter at the C5/6 intervertebral disc space measured 10 mm or less in 23% of patients with the neck in neutral alignment and 46% of patients with the neck placed in extension (Fig. 2). A midsagittal diameter of 10 mm is acknowledged as stenotic and consistent with symptomatic spinal cord compression, i.e., cervical myelopathy
