Positional Cervical Cord Compression

Positional Cervical Spinal Cord Compression (PC3) as a Comorbidity in Patients with Fibromyalgia (FM):  findings from a one-year retrospective study at an FM referral university.

CA1, Holman AJ2 1. OHSU, Portland, OR, USA, 2. Pacific Rheumatology, Renton, WA, USA.

OBJECTIVES: PC3, documented by dynamic MRI, was identified in 65% of community-based patients with FM (J Pain 2008; 9(7):613-22.). This study examines the prevalence of PC3 at an academic FM referral center.

METHODS: Sagittal flexion and extension images with measurement of the cervical canal diameter at each disk level were added to a traditional C-spine MRI to identify PC3. The prevalence and characteristics of FM+PC3+ patients seen in 2007 were assessed by retrospective chart analysis. PC3 was defined as abutment and/or compression of the cervical spinal cord with a canal diameter of <10mm.
 

RESULTS: Of 380 patients with FM by ACR criteria, 129 patients (9 M, 120 F, mean age 48.1 yrs.) received a dynamic MRI. 61 patients (47.3%) had PC3. There were 2 Chiari malformations. The extension view was required to document cord compression for 40/61 (67%). Most common disc herniations were found at C5-6 (38/61), C4-5(21/61), C6-7 (15/61) and C7-T1 (2/61). Most PC3 patients had single level compression (61%), while 31% had two, and 8% had three levels. 11/61 had surgical decompression. Exam features included + Romberg (49.6%), + Hoffman's (25.9%), Beighton score ≥5/9 (37.3%), hyporeflexia (14.8%), hyper-reflexia (46.7%), obstructive sleep apnea (48.1%). Pearson correlation and Chi-square analysis revealed a strong association with compression and positive Romberg (p<0.001), but not with other exam features.

CONCLUSIONS: These findings confirm PC3 as a common FM comorbidity in a referral cohort and the relative insensitivity (33%) of standard MR imaging to identify it.)

(Myopain 2010 Abstracts, October 3-7, 2010, Toledo, Spain)