Positional cervical cord compression may be present in patients with fibromyalgia
Results of a recently published study showed 57.4% of patients with fibromyalgia had positional cervical cord compression.
Based on research by Muhle and Resnick in 1998, Andrew J. Holman, MD, designed a study of 54 patients with fibromyalgia (FM) from the Seattle area and used noncontrast MRI to measure the cervical spine with two additional saggital flexion and extension views with spinal canal measurements at each disc. Canal narrowing below 10 mm at any level with clear, visual abutment of the cervical spinal cord by the commensurate disc and ligamentum flavum was used to define positional cervical cord compression (PC3).
“In humans, PC3 is so difficult to distinguish from FM without dynamic imaging that its validity and impact have been questioned,” the researchers wrote. “Given PC3 and FM symptom overlap, a blinded study was conducted.”
Patients were assessed using the Multidimensional Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, SF-36, Epworth Sleepiness Scale, Fatigue Severity Scale, Health Assessment Questionnaire, 16-item Quick Inventory of Depressive Symptoms and autonomic nervous system assessment by 5-minute, frequency domain, heart rate variability of parasympathetic, sympathetic and total power were also measured.
Although no clinical, historical or survey measures distinguished FM patients with or without PC3, 31 of the 54 patients presented with PC3 and all autonomic nervous system parameters significantly correlated with PC3. Parasympathetic scores were lower for patients with PC3 and higher for patients without PC3. Sympathetic scores were higher among patients with PC3 compared to patients without PC3, and the total power score was lower among patients with PC3 compared to patients without PC3.
“This study provides the first evidence that intermittent, positional abutment of the cervical cord is a potent sympathetic arousal in humans,” the researchers wrote. “It also highlights the challenge of diagnosing and addressing PC3 without imaging. Further investigation will sort out the role of PC3 in the diagnostic conundrum of FM, its pathogenesis and its treatment algorithms.” – by Shirley Pulawski
Holman AJ. Paper #75. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.
Disclosure: Holman reports no relevant financial disclosures.