Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications
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- 作者：Dan S. Heffez ; Ruth E. Ross ; Yvonne Shade-Zeldow ; Konstantinos Kostas ; Mary Morrissey ; Dean A. Elias and Alan Shepard
- 关键词：Cervical myelopathy ; Fibromyalgia ; Surgery ; Treatment outcome ; Case control study
- 刊名：European Spine Journal
- 出版年：2007
- 出版时间：September, 2007
- 年：2007
- 卷：16
- 期：9
- 页码：1423-1433
- 全文大小：188 KB
- 刊物类别：Medicine
- 刊物主题：Medicine & Public Health
Surgical Orthopedics
Neurosurgery - 出版者：Springer Berlin / Heidelberg
- ISSN：1432-0932
文摘
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.