While patients with fibromyalgia report symptoms consistent with cervical myelopathy, a detailed neurological evaluation is not routine.
We sought to determine if patients with fibromyalgia manifest objective neurological signs of cervical myelopathy.
I had never heard of this link between fibromyalgia and cervical myelopathy so this would be consistent with the theory that many fibromyalgia patients actually have EDS, which also leads to such types of cervical problems.
It seems this excellent information from over 10 years ago has been ignored by the medical establishment.
Two hundred and seventy patients, 18 years and older, who carried the diagnosis of fibromyalgia but who had no previously recognized neurological disease underwent detailed clinical neurological and neuroradiological evaluation for the prevalence of objective evidence of cervical myelopathy and radiological evidence of cerebellar tonsillar herniation (Chiari 1 malformation) or cervical spinal canal stenosis.
Patients were primarily women (87%), of mean age 44 years, who had been symptomatic for 8 years (standard deviation, 6.3 years).
The predominant complaints were
- neck/back pain (95%),
- fatigue (95%),
- exertional fatigue (96%),
- cognitive impairment (92%),
- instability of gait (85%),
- grip weakness (83%),
- paresthesiae (80%),
- dizziness (71%) and
- numbness (69%).
Eighty-eight percent of patients reported worsening symptoms with neck extension.
That certainly seems like absolute proof of cervical spine involvement.
The neurological examination was consistent with cervical myelopathy:
- upper thoracic spinothalamic sensory level (83%),
- hyperreflexia (64%),
- inversion of the radial periosteal reflex (57%),
- positive Romberg sign (28%),
- ankle clonus (25%),
- positive Hoffman sign (26%),
- impaired tandem walk (23%),
- dysmetria (15%) and
- dysdiadochokinesia (13%).
MRI and contrast-enhanced CT imaging of the cervical spine revealed stenosis.
The mean antero-posterior (AP) spinal canal diameter at C2/3, C3/4, C4/5, C5/6, C6/7 and C7/T1 was 13.5 mm, 11.8 mm, 11.5 mm, 10.4 mm, 11.3 mm and 14.5 mm respectively, (CT images).
In 46% of patients, the AP spinal diameter at C5/6 measured 10 mm, or less, with the neck positioned in mild extension, i.e., clinically significant spinal canal stenosis.
MRI of the brain revealed tonsillar ectopia >5 mm in 20% of patients (mean=7.1±1.8 mm), i.e., Chiari 1 malformation.
Our findings indicate that some patients who carry the diagnosis of fibromyalgia have both signs and symptoms consistent with cervical myelopathy, most likely resulting from spinal cord compression.
We recommend detailed neurological evaluation of patients with fibromyalgia in order to exclude cervical myelopathy, a potentially treatable condition.