Fibrocartilaginous embolism

Fibrocartilaginous embolism (FCE) occurs when materials that are usually found within the vertebral disc of the spine migrate into the nearby vascular system (veins and arteries) and block one of the spinal cord vessels. The exact cause of this migration is unclear, but symptoms often occur after a minor trauma.

FCE seems to occur most frequently in people who are in their late teens to their 20s and again in people who are in their 60s, but symptoms can begin anytime during adolescence or adulthood. This is thought to be because the vasculature in the spinal cord regresses as individuals enter young adulthood, and the vasculature increases again as people enter their 60s. Therefore, FCE is more likely to occur when there are more blood vessels located in and around the spinal cord. Some causes of FCE are thought to include aging, people who have fibrocartilaginous material (Schmorl nodes) built up in the vertebrae, or people who have spinal cord vasculature that is present throughout adulthood.

Risk factors for FCE include osteoporosis and a previous injury to the spinal cord such as a motor vehicle accident. FCE seems to be more common in women, which may be due to the increased likelihood for women to develop osteoporosis.

A diagnosis of fibrocartilaginous embolism (FCE) is generally suspected based on the presence of characteristic signs and symptoms. Other conditions that cause similar features can be ruled out using the following tests:

• Imaging of the spine with CT scan or MRI scan
• Cerebral spinal fluid (CSF collection)

Unfortunately, FCE is generally only confirmed with a biopsy, often performed at the time of autopsy. It is thought that FCE may be underdiagnosed and that it may be more common than originally thought.

Fibrocartilaginous embolism (FCE) is not known to run in families. Most cases occur sporadically in people with no family history of disease. However, it is possible for people in the same family to share risk factors that increase the likelihood for developing FCE.

The long-term outlook (prognosis) for people affected by fibrocartilaginous embolism (FCE) was once thought to be extremely poor with little hope for improvement of symptoms. However, more recent research has challenged this assumption. Many researchers now believe that there is a much wider spectrum of the severity and recovery associated with FCE. Researchers also suspect that the length and degree of recovery depends on many factors including:

• The location of FCE along the spinal cord
• The extent of spinal cord ischemia (restriction of blood supply to organs or tissues)

There is, unfortunately, no specific treatment for fibrocartilaginous embolism (FCE). Management is generally focused on preventing possible complications and improving quality of life with medications and physical therapy.

Treatments reported in the literature include surgery, steroid therapy, heparin administration, and/or blood pressure control. However, the benefits of these treatment options are not well-defined.