Shortness of filum terminale represents an anatomical specific feature in fibromyalgia: a nuclear magnetic resonance and clinical study

Abstract

Background: we aimed to assess whether shortness of filum terminale (FT) can represent a specific feature of fibromyalgia. Therefore we investigated benefits coming from FT section with a mini-invasive technique in patients with fibromyalgia. Filum terminale disease (FD), described firstly in 1996, is consequence of an abnormal traction exerted on spinal cord since FT is shorter than usual. Fibromyalgia syndrome (FS) is featured by chronic widespread musculoskeletal pain associated with stiffness and extra-skeletal symptoms affecting many organs and systems. Filum terminale disease and fibromyalgia syndrome share common clinical features in at least one subset of patients.

Methods: we evaluated 42 patients firstly diagnosed for FS and then re-evaluated by nuclear magnetic resonance. 38 out of 42 had also FD and 20 of them underwent surgical treatment, i.e., FT section according to Royo-Salvador technique.

Results: after physical therapy, surgically treated patients showed significant improvement of symptoms in terms of reduction of pain and increment of quality of life, compared to group, which refused surgery and performed physical therapy only.

Conclusion: we suggest that FT shortness can be considered one of predisposing causes for developing FS and that FD surgical treatment in patients with FS can improve overall treatment outcome.

Keywords: anatomical modification; fibromyalgia assessment status; fibromyalgia impact questionnaire; mini-invasive surgery; musculo-skeletal disorder; physical therapy.

Figure 1.

A–D. Relevant cervical (A–B) and lumbar (C–D) spine nuclear magnetic resonance images in patients with Fibromyalgia syndrome and Filum terminale disease. Images have been taken in a patient before (A, C) and after (B, D) section of FT. In particular, images show the distal position of cerebellar tonsils (arrow) before (A) and after (B) surgery and medullary cone (arrow) ending at second lumbar vertebra level both before (C) and after (D) surgery. L5 = fifth lumbar vertebra.

Figure 2.

Fibromyalgia Impact Questionnaire (FIQ) and self-administered Fibromyalgia Assessment Status (FAS) change (Δ%) between pre- and post-treatment in physical therapy group (PT) and surgery+physical therapy group (SPT). Data are showed as mean±SE, “*” represent significantly effect with p<0.001.