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 £ 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.

Surgery versus conservative care for neck pain: a systematic review

“…Six studies, four of which were CCTs, were identified which examined surgery versus non-surgical interventions in patients with radiculopathy [12][13][14][15][16][17]. Three studies, of which two CCTs, compared surgery versus nonsurgical interventions in myelopathy patients [18,19,20]. The RCT also reported the 10-year follow-up data [21].…”

“…All six CCTs were identified with a high risk of bias (Table 2) [12,13,14,17,19,20]. Two out of three RCTs also had a high risk of bias.…”

“…Four studies were identified which examined the effects of surgery versus non-surgical procedures, including one RCT [18] and two CCTs [19,20], all with high risk of bias.…”

“…For the 10-year follow-up in 47 patients also no difference in recovery was found. A CCT [19] (n = 71) examined the effects of decompression of the cervical spine or foramen magnum by Bold values indicate the significant findings a Data derived from graphs means of anterior discectomy and instrumented fusion, posterior cervical laminectomy with or without instrumented fusion or suboccipital decompression and duraplasty compared to a non-surgical treatment, which consisted of neck immobilization using a soft collar and physiotherapy. A statistical significant difference in improvement was found on the SF36 physical functioning score after 12 months follow-up, in favour of the surgical group.…”

A Possible Correlation Among Different Disease Activity Parameters and Functional Status in Patients with Ankylosing Spondylitis

“…[18] It has been reported that FM is more prevalent in female patients with AS, and it has also been found to be correlated with the BASDAI and BASFI. [19,20] Azevedo et al [20] reported that six out of 17 women in their study had FM, whereas only five out of 54 men were afflicted.…”