Cervical Sprain With Residual C1-C2 Laxity as Source of Fibromyalgia and Multiple Sclerosis Symptoms?

Abstract

Research Objectives To evaluate the upper cervical segmental mobility in patients with a remote history of trauma presenting with persistent fibromyalgia symptoms with evidence of persistent cervical sprain pain. Design Chart review. Setting Outpatient clinic. Participants Patients with history diagnosed with fibromyalgia and demonstrating (1) frequent headache on awakening, (2) pain/increased symptoms with neck range of motion, (3) pain with resistance to neck motion, (4) relief during cervical traction, (5) and typical fibromyalgia symptoms. Interventions CT of the cervical spine including rotation views. Main Outcome Measures Skeletal mobility per CT scan including Cranium, C1, and C2 rotation in degrees Results Analysis reveals that only one of the individuals had < 30 degrees rotation of C1 on C2, versus 14 of 20 having > 35 degrees and 7 of 20 having > 40 degrees rotation of C1 on C2 suggesting ligamentous laxity. Of note, none of the individuals had > 5 degrees rotation of cranium on C1, suggesting greater stability when compared to C1-C2. Conclusions In addition to upper spinal cord, the vertebral-basilar arteries supply the cerebellum, medulla oblongata, midbrain, pons, thalamus, and other areas in the posterior cranium. Symptoms of ischemia involving these areas include dizziness, gait disturbance, limb weakness, dysarthria, headache, nausea, cranial nerve, visual and other sensory dysfunctions. This sampling of persistent neck pain patients demonstrates significant rotational mobility that may involve the vertebral arteries at C1 and C2 in particular, contributing to symptoms similar to those with documented ischemia in the vertebrobasilar distribution. Alternatively, direct compression at cervical spinal cord-medullary junction from C1-2 laxity is illustrated in sagittal view MRI image. Here is seen anterior cranial migration relative to spinal canal compressing the spinal cord at its medullary junction. It is noteworthy that 4 individuals in this small sample developed plaque in the vertebrobasilar distribution and subsequently confirmed to have multiple sclerosis. Whether or not there is a relationship between ligamentous laxity in the upper cervical spine and development of fibromyalgia and/ or multiple sclerosis remains to be demonstrated. Author(s) Disclosures None to declare. To evaluate the upper cervical segmental mobility in patients with a remote history of trauma presenting with persistent fibromyalgia symptoms with evidence of persistent cervical sprain pain. Chart review. Outpatient clinic. Patients with history diagnosed with fibromyalgia and demonstrating (1) frequent headache on awakening, (2) pain/increased symptoms with neck range of motion, (3) pain with resistance to neck motion, (4) relief during cervical traction, (5) and typical fibromyalgia symptoms. CT of the cervical spine including rotation views. Skeletal mobility per CT scan including Cranium, C1, and C2 rotation in degrees Analysis reveals that only one of the individuals had < 30 degrees rotation of C1 on C2, versus 14 of 20 having > 35 degrees and 7 of 20 having > 40 degrees rotation of C1 on C2 suggesting ligamentous laxity. Of note, none of the individuals had > 5 degrees rotation of cranium on C1, suggesting greater stability when compared to C1-C2. In addition to upper spinal cord, the vertebral-basilar arteries supply the cerebellum, medulla oblongata, midbrain, pons, thalamus, and other areas in the posterior cranium. Symptoms of ischemia involving these areas include dizziness, gait disturbance, limb weakness, dysarthria, headache, nausea, cranial nerve, visual and other sensory dysfunctions.