Case Report: Recurrent cervical spinal stenosis masquerading as ME/CFS with orthostatic intolerance, 2023, C. Edwards, P. Rowe et al

Charles C. Edwards III1 Charles C. Edwards II2 Scott Heinlein3 Peter C. Rowe4*

Introduction:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic, multi-system disorder that is characterized by a substantial impairment in the activities that were well tolerated before the illness. In an earlier report, we had described three adult women who met criteria for ME/CFS and orthostatic intolerance, and had congenital or acquired cervical spinal stenosis. All three experienced substantial global improvements in their ME/CFS and orthostatic intolerance symptoms after recognition and surgical treatment of the cervical stenosis. After a several year period of improvement, one of the individuals in that series experienced a return of ME/CFS and orthostatic intolerance symptoms.

Main Symptoms and Clinical Findings:
Radiologic investigation confirmed a recurrence of the ventral compression of the spinal cord due to a shift of the disc replacement implant at the involved cervical spinal level.

Therapeutic Intervention:
Decompression of the spinal cord with removal of the implant and fusion at the original C5-C6 level was once again followed by a similar degree of improvement in function as had been observed after the first operation.This recapitulation of the outcomes after surgical management of cervical stenosis provides further evidence in support of the hypothesis that cervical spinal stenosis can exacerbate pre-existing or cause new orthostatic intolerance and ME/CFS. Especially for those with refractory symptoms and neurological signs, surgical interventions may offer relief for selected patients with this complex condition.

https://www.frontiersin.org/articles/10.3389/fneur.2023.1284062/abstract

 

What a strange way of defining ME/CFS.

 

I think it's a true definition. It's just not a very useful definition, since it also fits a vast number of other medical (and psychological?) problems. Actually, it also fits a shoelace breaking: can't tolerate that long walk the way I used to, with that shoe flopping loose.

 

Fulltext now available
https://www.frontiersin.org/articles/10.3389/fneur.2023.1284062/full

 

So this paper simply mentions that one of the 3 patients they described in an earlier paper, had relapsed, then got another surgery and improved again.

 

The sagittal MRI image (bottom left) looks almost trivial - certainly an appearance that would be very common and increasing in prevalence as people age > 40. You can see that there is still CSF anterior to the cord (white fluid signal). On the top right image in the panel, I've arrowed the right-sided disc herniation and you can see the cord has an oblique contour, compared to the level above in top-left image, but even then there is still CSF fluid signal between the disc herniation and the cord, which is odd.

MRI images with the patient's c-spine in neutral, lying supine so there could be a dynamic effect with flexion and extension. If this turns out to be a genuine contributor, perhaps there's an impairment of CSF flow that makes the difference. However, I'd have to wonder whether being under general anaesthesia for a couple of hours may be playing a significant role here. (We don't particularly know how general anaesthetic agents work and they may be taking their effect in lipid membranes.)