Background/Purpose: In patients with fibromyalgia a straight neck is based on calculating the Cobb angle, a standard radiographic measurement, of lateral view radiographs of the cervical spine.  Most fibromyalgia patients have lost the normal cervical lordosis.  We re-evaluated cervical spine radiographs of fibromyalgia patients to determine what proportion of FMS subjects have straight necks. 

Methods: The lordotic curve of cervical spine radiographs was measured by analyzing the Cobb angle in 138 consecutive patients in a rheumatology office practice. All patients met the ACR criteria for fibromyalgia and complained of moderate to severe neck pain. 23 additional patients with fibromyalgia followed in the same rheumatology practice had cervical radiographs reviewed visually by both a rheumatologist and an X-ray technician, but did not also have the Cobb angle measured (visual inspection group) The amount of visual curvature was noted by each as 1 (straight neck), 2 (slight lordotic curve) and 3 (normal lordotic curve).

Results: 98 of 138 (71%) fibromyalgia patients had a straight spine (Cobb angle less than 14 degrees). 24 of 138 (17%) fibromyalgia patients had a small lordotic curve of the lateral view of cervical spine radiographs (Cobb angle 14-18 degrees).  16 of 138 (12%) patients had a normal Cobb angle (more than 18 degrees) and a normal lordotic curve.

20 (87%) of 23 additional fibromyalgia patients (visual inspection group) had a straight cervical spine by visual inspection.  They had lost the normal lordotic curve.  3 (13%) fibromyalgia patients had a slightly curved cervical spine.  No fibromyalgia patient had a normal cervical lordosis by visual inspection of lateral views of radiographs of the cervical spine. The Cobb angle in 10 rheumatic disease controls was 22.5 degrees (and reported to be 26.8 degrees in healthy controls).

Conclusion: 88 % of fibromyalgia patients in this study had a straight neck based on measuring the Cobb angle, and 90 % had a straight neck (loss of the lordotic curve) by visualizing the lateral view of cervical spine radiographs.  The cause of the straight cervical spine in fibromyalgia is unknown. Speculation of the pathophysiology includes chronic muscle contraction and tightness of other soft tissues.

A straight cervical spine in the absence of other radiological abnormalities might assist in the diagnosis of fibromyalgia, and it may be important in attempting to understand the pathophysiology of this disorder.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-straight-neck-in-fibromyalgia/