Loss of neck Lordotic Curve (cervical lordosis) Is Characteristic of Fibromyalgia

[pattismith]

The Cervical Spine in Fibromyalgia Patients: Loss of Lordotic Curve Is Characteristic of Fibromyalgia and Can Assist in the Diagnosis

Robert S. Katz1, Alexandra Katz Small2, Ben J Small3 and Anthony Farkasch4, 1Rush University Medical Center, Chicago, IL, 2University of Illinois College of Medicine, Chicago, IL, 3Rheumatology, University of Illinois at Chicago Medical School, Chicago, IL, 4Rheumatology Associates S.C., Chicago, IL
Meeting: 2017 ACR/ARHP Annual Meeting
Date of first publication: September 18, 2017


Background/Purpose: Patients with fibromyalgia have widespread pain. We have found that a lateral view of a cervical spine radiograph frequently identifies a loss of the lordotic curve but otherwise normal architecture. We asked rheumatology nurse professionals to evaluate visually whether the cervical spine was straight on the lateral vie in fibromyalgia and non-fibromyalgia rheumatic disease patients.

Methods: 121 cervical spine radiographs were reviewed by a rheumatology nurse without knowledge of the patient’s diagnosis. Only the lateral view of the cervical spine was visualized to determine whether it was straight. A straight cervical spine is seen in fibromyalgia patients and may assist in the diagnosis. Other abnormalities of the cervical spine including disc space narrowing, osteophytes, spondylolisthesis, and reactive bony changes were also noted if present.

Results: Of the 121 cervical spine radiographs reviewed the rheumatology nurse, there were 84 patients with fibromyalgia, and 37 non-fibromyalgia rheumatic disease controls. Without being told the patients diagnosis, the nurse was able to correctly diagnosis 66 (75.5%) of the 84 fibromyalgia patients, and was able to accurately say that 29) of the control patients did not in fact have fibromyalgia.


Conclusion: A straight cervical spine can be used to assist in the diagnosis of fibromyalgia. The loss of lordotic curve without other radiographic abnormalities (disc space narrowing, reactive bony changes, etc.) is present in the majority of fibromyalgia patients and not in the non-fibromyalgia rheumatic disease patients. A straight cervical spine is further evidence of increased muscle tension in fibromyalgia.

 

[ljimbo423]

I have fibro and my neck often feels like it's in a vise, the muscle tension is so strong. This didn't make any sense to me until I read the last line, then it made perfect sense-

A straight cervical spine is further evidence of increased muscle tension in fibromyalgia.

 

[pattismith]

I have fibro and my neck often feels like it's in a vise, the muscle tension is so strong. This didn't make any sense to me until I read the last line, then it made perfect sense-

Hi ljimbo, I do have Fibro and I had great improvement with supraphysiologic Testosterone, which had given good results for fibro women. I also have neck problems for some years, and I realized some days ago that I have this loss of cervical lordosis. I opened a thread on that subject and while I was investigating this issue I found this study!

Isn't it amazing that both ME and Fibro seem to be associated with some cervical issue!

 

[pattismith]

according to my readings, Loss of cervical lordosis can have several origins, and I am surprised that they jump so quickly on the conclusion that the muscle tension is the root of it.

Apart from muscle tension, the known causes are:
-disc pathology (degeneration, bulked, hernia= 90 % of loss of lordosis in the neck
-ligament damage with posterior instability (interspinous ligaments damaged by hyperflexion)

I am not convinced that muscle tension is the root of LCL in Fibromyalgia, I think more investigations should be done to find if the LCL is a cause or a consequence of Fibro!

@Mary @Daffodil @Gingergrrl
this study may interest you, as you are LCL affected

 

[pattismith]

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury.
Buskila D1, Neumann L, Vaisberg G, Alkalay D, Wolfe F.
Author information

Abstract

OBJECTIVE:
To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS).

METHODS:
One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation; and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL).

RESULTS:
Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning.

CONCLUSION:
FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.



Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications
Dan S. Heffez,

1,2,4 Ruth E. Ross,1 Yvonne Shade-Zeldow,1 Konstantinos Kostas,1 Mary Morrissey,2 Dean A. Elias,2 and Alan Shepard3


2007
Go to:
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.

 

[pattismith]

Fibromyalgia and Positional Cervical Cord Compression Differ Only By Autonomic Nervous System Consequences: A Double-Blinded, Prospective Study

Andrew Holman, Pacific Rheumatology Reseach, Seattle, WA

Date: Sunday, November 8, 2015


Background/Purpose:
In 1998, C Muhle and D Resnick proposed a corollary to cervical spinal stenosis caused by intermittent abutment of the cervical spinal cord from dynamic shifting of degenerative discs with flexion and extension of the neck.
This positional cervical cord compression (PC3) has been documented in 54-71% of patients with fibromyalgia (FM) and was an exclusion criterion in the pramipexole FM randomized controlled trial. In animal models, PC3 is a potent sympathetic nervous system arousal.

In humans, PC3 is so difficult to distinguish from FM (without dynamic imaging) that its validity and impact have been questioned. Given PC3 and FM symptom overlap, a blinded study was conducted.

Methods: Patients diagnosed with fibromyalgia per American College of Rheumatology 1990 classification criteria were recruited from the Seattle area and after consent, were provided standard, non-contrast cervical spine magnetic resonance imaging (MRI) with two additional saggital flexion and extension views with spinal canal diameter measurement at each disc level.
PC3 was defined by a canal narrowing below 10 mm at any level WITH clear visual abutment of the cervical spinal cord by the commensurate disc and ligamentum flavum.

Double-blinded to the MRI results, subjects were assessed by history, physical examination, and a variety of surveys, including the Multidimensional Health Assessment Questionnaire (MDHAQ), Fibromyalgia Impact Questionnaire (FIQ), Short Form Health Survey (SF-36), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Health Assessment Questionnaire (HAQ), 16-item Quick Inventory of Depressive Symptoms (QIDS) as well as autonomic nervous system (ANS) assessment by 5-minute, frequency domain, heart rate variability (HRV) of parasympathetic, sympathetic and total power measures (Omegawave Ltd, Espoo, Finland).
Statistical analysis was conducted using Wilcoxon rank-sum for continuous variables and Fisher’s exact test for categorical variables.

Results: Fifty-four patients with FM participated in this study (92% women, mean age 45.2 years).
PC3 was identified in 31 of 54 subjects (57.4%).
All three ANS HRV measures demonstrated statistical significance.
Consistent with animal model data, parasympathetic score was lower 0.145 ± 0.067 for PC3+ patients and higher 0.198 ± 0.098 for PC3- patients (p=0.029). Sympathetic score was higher 61.0 ± 17.5 for PC3+ patients and lower 46.2 ± 15.8 for PC3- patients (p=0.005). Total power score was lower 440 ± 492 for PC3+ patients and higher 1633 ±4232 for PC3- patients (p=0.022).
No clinical, historical or survey measures distinguished PC3-FM+ patients from PC3+FM+ patients.

Conclusion: This study provides the first evidence that intermittent, positional abutment of the cervical cord is a potent sympathetic arousal in humans. It also highlights the challenge of diagnosing and addressing PC3 without imaging. Further investigation will to sort out the role of PC3 in the diagnostic conundrum of FM, its pathogenesis and its treatment algorithms.

 

[pattismith]

I have fibro and my neck often feels like it's in a vise, the muscle tension is so strong. This didn't make any sense to me until I read the last line, then it made perfect sense-

It doesn't make sense to me for two reasons:
my fibro symptoms increases with anything that increase muscle weakness
-low T3
-low testosterone

and it decreases with everything that improves my muscle tone
-improve thyroid function
-testosterone
-stress (flight or fight)

Testosterone supplementation especially quickly improve most of my fibro symptoms, so I tend to think that my loss of cervical lordosis could be the result of some instability with damage of posterior ligaments of the spine.
If this LCL was a result of excess muscle tension, testosterone (which increase muscle tone) might not improve fibro (and it was shown not only for me but for many fibro women, see the study about it)...

 

[Gingergrrl]

@Mary @Daffodil @Gingergrrl this study may interest you, as you are LCL affected

I just realized that you tagged me in this thread, Patti, but in my case, I don't have fibro and not sure it pertains to me? My neck pain originated from a serious car accident in 2006 (where I was hit at a fast speed and my car flipped upside down). Then in 2010, my right arm (triceps tendon) was severely injured/ damaged from Levaquin (FQ antibiotic) so my right shoulder/neck had to compensate for my arm for about 1.5 years.

I learned to do as much as humanly possible with my left arm (even use the mouse on computer which I still do today) even though I am right-handed. So between the car accident and Levaquin damage, I know how and why my neck & arm pain/ weakness started but I have yet to find anything to make it go away. But I find ideas constantly on PR that I want to try and keep a running list.

Would either of those things (car accident or Levaquin damage) lead to loss of lordosis or cervical radiculopathy (on the right side of my neck/arm)?

 

[pattismith]

Impaired Trunk Posture in Women With Fibromyalgia
Sempere-Rubio, Núria, MSc∗; Aguilar-Rodríguez, Marta, PhD∗; Espí-López, Gemma V, PhD∗; Cortés-Amador, Sara, PhD∗; Pascual, Eliseo, PhD†; Serra-Añó, Pilar, PhD∗
Spine: November 15, 2018 - Volume 43 - Issue 22 - p 1536-1542


Study Design. A cross-sectional study.

Objectives. The main goal of the study was to analyze posture of Fibromyalgia syndrome (FMS) in women compared with healthy subjects to establish if posture assessment could be useful to characterize the syndrome. Secondarily, we explored the impact of sedentary behavior on trunk posture.

Summary of Background Data. Pain has been associated with poor static postures, however there is little information on the effect of FMS, which is characterized by widespread pain, on trunk posture.

Methods. One hundred eighteen women with FMS and 110 healthy counterparts participated in this study, in which trunk posture was assessed. The thoracic kyphosis, forward head position, and shoulder position (basal and maximum protraction) were measured. Further, maximum shoulder protraction and the ability to maintain the cervical and thoracic angle were assessed. To compare the differences in posture depending on the grouping, an independent Student t test was conducted. To analyze the differences between groups in the ability to maintain the position over a period of time and the differences in posture depending on more or less active lifestyles, two multivariate analysis of variance were performed.

Results. The results showed a significantly larger thoracic kyphosis, baseline shoulder protraction and lower craniovertebral angle and maximum protraction in FMG compared with CG (P < 0.05). FMG subjects exhibited an impaired ability to maintain the cervical and thoracic angles, as this varied throughout the test, unlike those of their counterparts. A sedentary lifestyle did not affect trunk posture in the FMS participants.

Conclusion. FMS female population present an altered trunk posture and an inability to maintain trunk position. Since this does not appear to be influenced by a more or less active lifestyle, specific treatment programs are needed to manage this clinical condition.

 

[Mary]

according to my readings, Loss of cervical lordosis can have several origins, and I am surprised that they jump so quickly on the conclusion that the muscle tension is the root of it.

Apart from muscle tension, the known causes are:
-disc pathology (degeneration, bulked, hernia= 90 % of loss of lordosis in the neck
-ligament damage with posterior instability (interspinous ligaments damaged by hyperflexion)

I am not convinced that muscle tension is the root of LCL in Fibromyalgia, I think more investigations should be done to find if the LCL is a cause or a consequence of Fibro!

@Mary @Daffodil @Gingergrrl
this study may interest you, as you are LCL affected

Hi @pattismith - I missed this earlier, thanks for tagging me. I don't have fibro, though I do have tight muscles in my neck. I think they're trying to hold my head in place. My cevical vertebrae do have some damage, possibly originating from something very heavy which fell on my head when I was 11, a long time ago. I've just started cranialsacral therapy to see if it can help. I have had my Atlas vertebra adjusted twice, it made no difference in my symptoms. I do want to look into physical therapy but have to figure out how to get it! I think I need a doctor's referral and am not looking forward to trying to explain to a neurologist why I want PT!

 

[pattismith]

it's interesting to read those two studies below...

Neck loss of lordosis is associated with

-changes in neck muscle masses (smaller extensor muscles, bigger flexor muscles...)
-change in cerebral blood flow

This may explains why after some hours standing I have the feeling my brain is no longer irrigated


The last article suggests that improving/restoring neck curvature immediately improves cerebral blood flow.


Association between cervical lordotic curvature and cervical muscle cross‐sectional area in patients with loss of cervical lordosis - Yoon - 2018 - Clinical Anatomy - Wiley Online Library

Partial correlation analysis revealed that the cervical lordotic angle was significantly positively correlated with the ratio of flexor to extensor muscle CSAs (P < 0.05). There is a significant relationship between cervical muscle imbalance, including extensor muscle weakness, and loss of cervical lordosis. An exercise program focusing on cervical extensor muscle strengthening and restoring the balance of flexor and extensor muscles is recommended for patients with loss of cervical lordosis.

Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis - PMC (nih.gov)

The results of this case series show that correction of loss of cervical lordosis was associated with increased cerebral artery parameters indicating an immediate increase in blood flow in the brain

it seems that they use the Denneroll Cervical Medium Orthotic Unit in this study:

Denneroll Cervical Medium Orthotic Traction Unit – Spinal Health Distributors (dennerollspinalorthotics.ca)