Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

Heffez, Dan S.; Ross, Ryan E.; Shade-Zeldow, Yvonne; Kostas, Konstantinos; Shah, Sagar; Gottschalk, Robert; Elias, D; Shepard, Alan; Leurgans, Sue E.; Moore, Charity G.

doi:10.1007/s00586-004-0672-x

Cited by 44 publications

(38 citation statements)

References 47 publications

(94 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other upper limb clinical sign commonly found was upper limb hyper-reflexia (72%). These findings are similar to the ones reported by other authors [3,15]. The walking Romberg test was the second most prevalent clinical sign (see Table 1).…”

Section: Discussionsupporting

confidence: 92%

Does walking change the Romberg sign?

et al. 2009

View full text Add to dashboard Cite

The Romberg sign helps demonstrate loss of postural control as a result of severely compromised proprioception. There is still no standard approach to applying the Romberg test in clinical neurology and the criteria for and interpretation of an abnormal result continue to be debated. The value of this sign and its adaptation when walking was evaluated. Detailed clinical examination of 50 consecutive patients of cervical myelopathy was performed prospectively. For the walking Romberg sign, patients were asked to walk 5 m with their eyes open. This was repeated with their eyes closed. Swaying, feeling of instability or inability to complete the walk with eyes closed was interpreted as a positive walking Romberg sign. This test was compared to common clinical signs to evaluate its relevance. Whilst the Hoffman's reflex (79%) was the most prevalent sign seen, the walking Romberg sign was actually present in 74.5% of the cases. The traditional Romberg test was positive in 17 cases and 16 of these had the walking Romberg positive as well. Another 21 patients had a positive walking Romberg test. Though not statistically significant, the mean 30 m walking times were slower in patients with traditional Romberg test than in those with positive walking Romberg test and fastest in those with neither of these tests positive. The combination of either Hoffman's reflex and/or walking Romberg was positive in 96% of patients. The walking Romberg sign is more useful than the traditional Romberg test as it shows evidence of a proprioceptive gait deficit in significantly more patients with cervical myelopathy than is found on conventional neurological examination. The combination of Hoffman's reflex and walking Romberg sign has a potential as useful screening tests to detect clinically significant cervical myelopathy.

show abstract

Section: Discussionsupporting

confidence: 92%

Does walking change the Romberg sign?

et al. 2009

View full text Add to dashboard Cite

show abstract

“…These patients do not differ from the larger untreated cohort with regards to duration of illness, mean age, antecedent craniospinal trauma, the prevalence of individual symptoms or the prevalence of individual neurological signs [17].…”

Section: Non-surgical Treatmentmentioning

confidence: 67%

“…Clinical evidence for cervical myelopathy due to spinal cord or caudal brain stem compression was surprisingly common [17]. The question was raised as to whether, despite the similarities in symptoms, the presence of cervical myelopathy in this cohort was a mere coincidence or whether in this cohort, cervical myelopathy was the underlying cause of the patients' symptoms.…”

Section: Discussionmentioning

confidence: 88%

“…The imaging techniques have been previously reported [17]. For the purpose of determining the position of the cerebellar tonsils, the lower lip of the foramen magnum was defined as extending from the lowest cortical bone of the clivus anteriorly (basion) to the lowest cortical bone at the opistion posteriorly on the mid sagittal MRI image.…”

Section: Radiological Imagingmentioning

confidence: 99%

“…We previously reported the radiological and neurological findings in non-randomly selected patients with fibromyalgia, documenting the presence of cervical myelopathy and cervical spinal cord compression in a cohort of 270 patients [17]. A subset of this cohort underwent treatment of cervical myelopathy by surgical or non-surgical means.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

et al. 2007

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Neurologic signs and symptoms in fibromyalgia

Watson¹,

Buchwald²,

Goldberg³

et al. 2009

Arthritis & Rheumatism

View full text Add to dashboard Cite

Objective. To determine the type and frequency of neurologic signs and symptoms in individuals with fibromyalgia (FM).Methods. Persons with FM (n ‫؍‬ 166) and painfree controls (n ‫؍‬ 66) underwent systematic neurologic examination by a neurologist blinded to disease status. Neurologic symptoms lasting at least 3 months were assessed with a standard questionnaire. We used logistic regression to evaluate the association of neurologic symptoms and examination findings with FM status. Within the FM group we examined the correlation between self-reported symptoms and physical examination findings.Results. Age-and sex-adjusted estimates revealed that compared with the control group, the FM group had significantly more neurologic abnormalities in multiple categories, including greater dysfunction in cranial nerves IX and X (42% versus 8%) and more sensory (65% versus 25%), motor (33% versus 3%), and gait (28% versus 7%) abnormalities. Similarly, the FM group had significantly more neurologic symptoms than the control group in 27 of 29 categories, with the greatest differences observed for photophobia (70% versus 6%), poor balance (63% versus 4%), and weakness (58% versus 2%) and tingling (54% versus 4%) in the arms or legs. Poor balance or coordination, tingling or weakness in the arms or legs, and numbness in any part of the body correlated with appropriate neurologic examination findings in the FM group.Conclusion. This blinded, controlled study demonstrated neurologic physical examination findings in persons with FM. The FM group had more neurologic symptoms than did the controls, with moderate correlation between symptoms and signs. These findings have implications for the medical evaluation of patients with FM.

show abstract

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia

Cited by 44 publications

References 47 publications

Does walking change the Romberg sign?

Does walking change the Romberg sign?

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

Neurologic signs and symptoms in fibromyalgia

Contact Info

Product

Resources

About