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Surgery for Fibromyalgia?

Robert Bennett MD

 If you are visiting this page you have probably heard about the surgical treatment of fibromyalgia, namely a decompression operation on either the base of the brain or the neck spine (cervical spine). The disorders for which this surgery is being performed are called Chiari I Malformation and Cervical Spinal Stenosis.

Dr. Thomas Milhorat, Chief of Neurosurgery at State University of New York, recently reported on 364 patients in the Journal of Neurosurgery whom he had operated on for a Chiari I malformation. Diagnoses given by other physicians prior to surgery included: psychological problems - 59, migraine - 42, fibromyalgia - 37 and multiple sclerosis - 22. The most common symptom was headaches spreading from the back of the skull to behind the eyes and down to the neck and shoulders. Other symptoms included: blurred vision, floaters, visual field cuts, dizziness, tinnitus, vertigo, throat pain, sleep apnea, shortness of breath, numbness/tingling, muscle weakness and difficulty swallowing.

The surgeons who are currently doing most of this surgery on fibromyalgia patients are:

1. Dr. Michael Rosner at Park Ridge Hospital in Fletcher, N.C

2. Dr. Daniel Heffez at the Neurosurgical Institute in Chicago.

3. Dr. John D. Weingart at Johns Hopkins University Medical Center.

As with any new venture in medicine this type of surgery has proponents and critics. The controversial nature of this surgery was recently highlighted by a front page article in the
Wall Street Journal.

A study to compare the prevalence of Chiari I malformation and Cervical Spinal Stenosis in fbromyalgia patients and healthy controls was conducted by Drs. Dan Clauw (Georgetown Univ.) and Robert Bennett (Oregon Health and Science University) with funding from the National Fibromyalgia Research Association (NFRA). This study did not find an increased prevalence of Chiari I Malformation or Cervical Spinal Stenosis in fibromyalgia patients. The results of this study were presented by Dr. Rosner at the American College of Rheumatology Annual Meeting in Philadelphia in November of 2000 - see Abstract of Presentation

The bottom line is: this surgery is for Chiari I Malformation and Cervical Spinal Stenosis; it is not for Fibromyalgia by itself. If you happen to have fibromyalgia and one of these other 2 diagnoses you may be a candidate for surgery. It costs about $30,000.
You should only consider this surgery if a specially trained physician can demonstrate that you have abnormal neurological findings on physical examination and that these findings can be correlated with certain abnormalities on MRI of the base of the skull and/or neck.





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