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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1423-1433 |
| Number of pages | 11 |
| Journal | European Spine Journal |
| Volume | 16 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2007 |
Funding
Acknowledgments We would like to thank Dr. Peter Rowe (Professor of Pediatrics, The Johns Hopkins Hospital) for review and very constructive criticism of the manuscript. We would like to thank Sue E Leurgans Ph.D. (Professor, Dept. of Preventative Medicine, Rush University) for assistance with initial study design. We would like to thank Sagar Shah, Dr. Kareem Foloshade and Melissa Martinez for meticulous data entry. Funding support—this work was supported in part by a grant from the National Fibromyalgia Research Association which played no part in study design, data review or analysis or manuscript preparation.
Keywords
- Case control study
- Cervical myelopathy
- Fibromyalgia
- Surgery
- Treatment outcome
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine