title: Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications.
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 <or= 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.
authors.affiliation: Chicago Institute of Neurosurgery and Neuroresearch Medical Group, Chicago, USA. dheffez@mmi-wi.org
authors.forename: Dan S
authors.initials: DS
authors.lastname: Heffez
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Ross
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Shade-Zeldow
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kostas
authors.forename: Mary
authors.initials: M
authors.lastname: Morrissey
authors.forename: Dean A
authors.initials: DA
authors.lastname: Elias
authors.forename: Alan
authors.initials: A
authors.lastname: Shepard
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000601:surgery; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000628:therapy*; D000077206:Gabapentin; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D013118:Spinal Cord Diseases / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin