Case report: Recurrent cervical spinal stenosis masquerading as myalgic encephalomyelitis/chronic fatigue syndrome with orthostatic intolerance.
Edwards, Charles C, Edwards, Charles C, Heinlein, Scott et al. · Frontiers in neurology · 2023 · DOI
Quick Summary
This case report describes a woman who was thought to have ME/CFS and experienced symptoms of dizziness upon standing (orthostatic intolerance). Doctors discovered she actually had cervical spinal stenosis—a narrowing of the spinal canal in her neck that was compressing her spinal cord. After surgery to relieve the compression, her ME/CFS and orthostatic intolerance symptoms improved significantly. Years later, her symptoms returned because the surgical implant shifted, compressing the spinal cord again. A second surgery provided similar improvement, suggesting that spinal stenosis may have been causing or worsening her ME/CFS symptoms rather than the other way around.
Why It Matters
For ME/CFS patients with orthostatic intolerance and neurological symptoms that are difficult to treat, this study highlights the importance of considering structural spinal pathology in the differential diagnosis. The finding that symptom recurrence paralleled imaging findings of re-compression provides stronger mechanistic evidence than the initial series, suggesting surgical intervention may benefit a carefully selected subset of ME/CFS patients with underlying cervical stenosis.
Observed Findings
Patient experienced substantial improvement in both ME/CFS and orthostatic intolerance symptoms following surgical decompression of cervical spinal stenosis at C5-C6.
Several years after initial surgery, symptoms recurred and imaging confirmed ventral spinal cord compression due to disc replacement implant migration.
Second decompression surgery with implant removal and fusion produced similar degree of functional improvement as the first operation.
Radiologic findings (implant shift causing re-compression) directly correlated with timing of symptom recurrence.
Inferred Conclusions
Cervical spinal stenosis can exacerbate or cause ME/CFS and orthostatic intolerance symptoms in some patients.
The recurrence of symptoms with re-compression and improvement with re-decompression supports a mechanistic link between spinal cord compression and ME/CFS-like presentations.
For selected patients with ME/CFS, refractory symptoms, and neurological signs, surgical decompression may offer substantial clinical benefit.
Remaining Questions
What proportion of ME/CFS patients have underlying cervical spinal stenosis, and what screening criteria should be used to identify appropriate candidates for imaging evaluation?
Are there specific clinical or neurological features that distinguish ME/CFS patients with surgically remediable stenosis from those with primary ME/CFS?
What This Study Does Not Prove
This case report does not prove that cervical spinal stenosis causes ME/CFS in the general ME/CFS population, nor does it establish how common this overlap is. It cannot demonstrate causation definitively, only association in this individual patient. The findings cannot be generalized beyond patients with specific neurological signs and imaging-confirmed stenosis, and do not address whether most ME/CFS patients would benefit from similar screening or intervention.
Tags
Symptom:Orthostatic IntoleranceFatigue
Biomarker:Neuroimaging
Method Flag:No ControlsSmall SampleExploratory Only
What is the long-term durability of surgical outcomes in this patient population, and what factors predict implant stability and symptom recurrence?
How should clinicians balance the risks and benefits of surgical intervention in ME/CFS patients with imaging-confirmed but asymptomatic spinal stenosis?