Interview:  Can spinal surgery really help?

Chiari malformation, where part of the brain extends beyond the base of the skull and presses on the brain stem and spinal cord, and cervical stenosis, where the spinal canal is too narrow for the spinal cord, are beginning to be suspected as the cause of symptoms in some patients with chronic fatigue and immune dysfunction syndrome (CFIDS) or fibromyalgia (FM). Dr. Dan Heffez, a Chicago neurosurgeon with 13 years of experience in correcting Chiari and cervical stenosis, recently presented data at a meeting of the National Fibromyalgia Research Association. In this brief interview, he shared some of his findings with The CFIDS Chronicle.

The CFIDS Chronicle:   Had these patients seen other practitioners before they came to you?

Dr. Daniel Heffez (DH):   Yes. The data I presented was based on 77 patients I have treated with CFIDS or FM. On average, they had been experiencing their symptoms for seven years; most were referred by another health care practitioner who suspected chiari or cervical stenosis. About 1/3 said they had seen an acupuncturist. Almost all had seen a family physician, 2/3 a rheumatologist, 1/2 an internist, and 1/3 an anesthesiologist. About half had seen a psychologist or psychiatrist. Interestingly enough, 2/3 had also seen a neurologist before coming to me, but most were not referred on by the neurologist for surgery.

Which is more common in this group, Chiari or cervical stenosis?
DH:   They are really equally as common, and what most people don't realize is that they can occur together. Sixty-six of the 77 had cervical stenosis and 55 had Chiari, which means that 28 had both. When a patient has both conditions, I will usually fix the most serious malformation first, based on their MRI and x-ray findings. Then, if it is warranted and the first surgery does not provide the patient enough relief, we perform a second surgery to rectify the other problem.

Since these conditions are thought to be present at birth, what had triggered the symptoms?
DH:   There is not one answer that holds true for everyone, but 71% of these patients said that they had a head injury or had been in a motor vehicle accident close to the time that the symptoms started.

Did all of these patients have surgery?
DH:   No, some cases are not severe enough to warrant immediate surgery. Less invasive treatments I recommend are wearing a cervical collar, receiving training in posture and body mechanics and a brief course of steroids (no more than a week) to reduce inflammation. I also discourage patients from engaging in any exercises that involve repeated motion of the neck and tell them to lie down for 10-15 minutes when they begin to feel worse, before their symptoms have a chance to progress. These measures reduce pressure on the spine and may help some patients avoid surgery if their x-ray findings are not too severe.

How much improvement was there for patients who did have surgery?
DH:   The results were very impressive. Nearly 100% of patients who were disoriented, dizzy, hurt all over, or were experiencing headaches, trouble sleeping, poor eye-hand coordination or numbness in their limbs showed improvement or complete resolution of the problem up to six months after surgery. More than 75% of those who had irritable bowel syndrome, short-term memory or concentration difficulties or vision problems had improved or were back to normal up to six months after surgery. And more than 60% saw improvement or resolution of their abnormal reflexes, muscle weakness or fatigue within the same time period.

How did you determine whether they had improved?
DH:   We examined them prior to surgery, then asked patients to fill out a detailed questionnaire and have another neurological examination at the end of six months. So we verified that what they thought was an improvement was really an improvement. We continue to follow every patient with a questionnaire every three months for a year.

How quickly did most patients notice a difference?
DH:   The majority said that they saw some improvement almost immediately after the surgery, and that within a month they felt much better than before. Let me stress that this is not every patient. Surgery should not be seen as a "magic bullet" or cure-all.

Do you think there's a connection between CFIDS/FM and these conditions?
DH:   It is too soon to know if either Chiari or cervical stenosis causes every case of CFIDS or FM, and if so, whether it is the only cause. My gut feeling is that there is far too high an incidence of these conditions in these two groups for there not to be some sort of causal connection. But we need to wait to examine the data over a longer period of time.