Fibrocartilaginous Embolic Myelopathy Research Articles

Outcome in paraplegic dogs with or without pain perception due to thoracolumbar fibrocartilaginous embolic myelopathy or acute non-compressive nucleus pulposus extrusion.

Fibrocartilaginous embolic myelopathy (FCEM) and acute non-compressive nucleus pulposus extrusion (ANNPE) are common causes of acute spinal cord injury in dogs. Outcome among paraplegic deep pain positive (DPP) and deep pain negative (DPN) dogs with either condition and factors influencing recovery have not been clearly established. Dogs with thoracolumbar FCEM or ANNPE resulting in paraplegia presenting to university hospitals between 2012 and 2022 were retrospectively included. Diagnosis of FCEM or ANNPE was based on clinical and magnetic resonance imaging findings. Outcome was defined as successful (recovery of independent ambulation) or unsuccessful (non-ambulatory ≥3 months following diagnosis or at the time of death/euthanasia). Logistic regression analysis was performed to investigate associations between clinical or imaging variables and outcome. Thirty-one dogs were included. In total, 14 dogs were initially paraplegic DPP (8 FCEM, 6 ANNPE) and 17 dogs were paraplegic DPN (11 FCEM, 6 ANNPE). Outcome was available for 26 dogs (14 DPP, 12 DPN) with a median follow-up time of 182 days (range 0-2,311) including 2 dogs euthanized at the time of diagnosis; 1 of 12 DPN dogs (8.3%) regained independent ambulation, whereas 9 of 14 DPP dogs (64.3%) regained independent ambulation. DPN dogs had a significantly higher risk of not regaining independent ambulation compared with DPP dogs (OR: 47.40, 95% CI: 2.09-1073.99). No other variables were associated with outcome. While recovery of ambulation was possible, these results confirm that the absence of pain perception is a useful negative prognostic indicator in dogs with severe thoracolumbar FCEM or ANNPE.

Case Report of Fibrocartilaginous Embolic Myelopathy of the Spinal Cord in a Female Dog

Introduction: Fibrocartilaginous embolic myelopathy is a non-progressive injury in the spinal cord that can cause infarction in veins of spinal parenchyma which leads to ischemia and necrosis.
 Case report: Fibrocartilaginous embolic myelopathy was diagnosed in a 4-year-old, female, Spitz dog using the clinical neurological examination. The dog was hospitalized, and the treatment including supportive treatment and Cortone was set up for three weeks. Then Diazepam and Methocarbamol were added to the prescription and treatment continued for two weeks. A general improvement was noted after three weeks, and the dog could stand perfectly after 5 weeks.
 Conclusion: Three weeks of supportive treatment, Cortone therapy as well as the addition of Diazepam and Methocarbamol to the treatment could help the dog to stand on its feet. However, cannot be ignored that knowing about the history of the dog played an important role in its treatment procedure.

Comparison of magnetic resonance imaging findings in relation to body weight in dogs with thoracolumbar disease.

To compare the incidence of MRI lesions between dogs weighing < 15 kg (33 lb) and dogs weighing ≥ 15 kg. 494 dogs with clinical signs of thoracolumbar disease. Electronic medical records of affected dogs that underwent MRI of the thoracolumbar vertebral column between January 2016 and July 2018 were reviewed. Data extracted included age, body weight, breed, sex, MRI findings, and lesion location. Data were compared between dogs weighing < 15 kg and dogs weighing ≥ 15 kg. Of dogs weighing < 15 kg, 94.4% (371/393) were chondrodystrophic breeds. Only 24.8% (25/101) of dogs weighing ≥ 15 kg were chondrodystrophic breeds. Lesions consistent with intervertebral disk disease (IVDD) had an overall incidence of 87.2% (431/494). In dogs weighing < 15 kg, the incidence of IVDD was 94.7% (372/393), compared with 58.4% (59/101) in dogs weighing ≥ 15 kg. Dogs weighing < 15 kg had a significantly higher incidence of IVDD lesions in the T12-13 segment, compared with dogs weighing ≥ 15 kg. Dogs weighing ≥ 15 kg were 11.9 times (95% CI, 5.1 to 27.9) and 7.4 times (95% CI, 2.3 to 23) as likely to have a neoplastic lesion and fibrocartilaginous embolic myelopathy, respectively, compared with dogs weighing < 15 kg. IVDD was the most common MRI finding in the study population. Dogs weighing ≥ 15 kg had a higher incidence of nonintervertebral disk lesions, compared with dogs weighing < 15 kg.

Nucleus Polposus Embolism Causing Anterior Spinal Artery Occlusion: A Rare but Possible Cause of Fibrocartilaginous Embolic Myelopathy.

Fibrocartilaginous embolic myelopathy (FCEM) is a rare cause of spinal cord infarction. It has been confirmed by autopsy in postmortem cases. Herein we describe a case of FCEM diagnosed based on clinical grounds. A 58-year-old man presented with acute onset of complete paraplegia with bladder and bowel involvement developing a few hours after a trivial trauma. There were no upper motor neuron signs. His magnetic resonance imaging (MRI) was suggestive of longitudinally extensive transverse myelitis from T5 to the conus. There was left paracentral disc protrusion at the T4-T5 level. However, no features of inflammatory, infectious, or autoimmune etiology were found on history, on examination, or in blood or cerebrospinal fluid analysis, and there was no contrast enhancement on MRI. A diagnosis of anterior spinal artery occlusion was made based on clinical examination with sparing of posterior column sensations in the lower limbs, predominant involvement of anterior half of the spinal cord on MRI, and accompanying new onset of back pain with rapid symptom progression to nadir as opposed to inflammatory etiology. Fibrocartilaginous embolism was suspected after ruling out all other causes of vascular compromise and presence of disc herniation at T4-T5. He was managed with rehabilitation and showed no signs of recovery. FCEM, though rare, should be kept in mind as a differential diagnosis of acute medical myelopathy when no other cause can be identified.

Fibrocartilaginous embolic myelopathy: demographics, clinical presentation, and functional outcomes.

Retrospective cohort study. To describe the demographics, clinical presentation, and functional outcomes of fibrocartilaginous embolic myelopathy (FCEM). Academic inpatient rehabilitation unit in the midwestern United States. We retrospectively searched our database to identify patients admitted between January 1, 1995 and March 31, 2016, with a high probability of FCEM. Demographic, clinical, and functional outcome measures, including Functional Independence Measure (FIM) information was obtained by chart review. We identified 31 patients with findings suggestive of FCEM (52% male), which was 2% of the nontraumatic spinal cord injury population admitted to inpatient rehabilitation. The age distribution was bimodal, with peaks in the second and sixth-to-seventh decades. The most common clinical presentation was acute pain and rapid progression of neurologic deficits consistent with a vascular myelopathy. Only three patients (10%) had FCEM documented as a diagnostic possibility. Most patients had paraplegia and neurologically incomplete injuries and were discharged to home. Nearly half of the patients required no assistive device for bladder management at discharge, but most were discharged with medications for bowel management. Median FIM walking locomotion score for all patients was 5, but most patients were discharged using a wheelchair for primary mobility. Median motor FIM subscale score was 36 at admission and 69 at discharge, with a median motor efficiency of 1.41. FCEM may be underdiagnosed and should be considered in those with the appropriate clinical presentation, because their functional outcomes may be more favorable than those with other causes of spinal cord infarction.

Mielopatia por embolismo fibrocartilaginoso em um canino

Fibrocartilaginous embolic myelopathy is a syndrome of spinal cord infarction caused by fibrocartilaginous emboli identical to the nucleus pulposus of the in...

Clinical, clinicopathological and diagnostic imaging findings in 14 dogs with suspected fibrocartilaginous embolic myelopathy

Fibrocartilaginous embolic myelopathy was diagnosed in 14 dogs with acute neurological dysfunction, based on history, findings of clinical examination, diagnostic imaging evaluation, follow-up and outcome. The dogs were presented with signs of variable involvement of the spinal cord, which were lateralized in 4 cases. The initial clinicopathological evaluation was unremarkable, while cerebrospinal fluid analysis was abnormal in one dog. Diagnostic imaging investigation (plain radiographs of the spinal column and myelography) did not reveal any abnormalities in the vertebrae and adjacent tissues or compression of the spinal cord, with the exception of one case, where there was evidence of focal intramedullary oedema corresponding to the lesion location. Seven dogs improved significantly with supportive treatment; complete remission of clinical signs was evident in two. Moderate improvement was seen in three animals and minimal or no improvement in four dogs, which were euthanised due to persisting neurological incapacitation.

Poster 130: Fibrocartilaginous Embolic Myelopathy: Functional Outcomes in a Retrospectively Identified Pediatric Cohort

Poster 130: Fibrocartilaginous Embolic Myelopathy: Functional Outcomes in a Retrospectively Identified Pediatric Cohort

Outcome comparison in dogs with a presumptive diagnosis of thoracolumbar fibrocartilaginous embolic myelopathy and acute non-compressive nucleus pulposus extrusion

Dogs with fibrocartilaginous embolic myelopathy (FCEM) or acute non-compressive nucleus pulposus extrusion (ANNPE) are reported to have a fair prognosis; however, persistent motor/autonomic deficits are possible. Specific MRI patterns have...

Clinical characteristics of canine fibrocartilaginous embolic myelopathy (FCE): a systematic review of 393 cases (1973–2013)

Fibrocartilaginous embolic myelopathy (FCE) is common in dogs; however, there is conflicting information in the veterinary literature regarding clinical characteristics and data on recovery in severe cases is sparse. A...

Fibrocartilaginous Embolism Associated with the Extrusion of the Intervertebral Disc in a Dog

Background: Intervertebral disc disease is a usual neurological disorder in dogs, which the spinal cord is compressed by intervertebral disc extrusion or protrusion. Fibrocartilaginous embolic myelopathy isan acute infarction disease of spinal cord caused by fibrocartilaginous emboli histologically identical to the nucleus pulposus of intervertebral discs. The aim of this report is present two cases of fibrocartilaginous embolic myelopathy in dogs with intervertebral disc disease.Cases: Two dogs - dachshund breed - were referred to the Veterinary Medical Teaching Hospital of the UFSM. In the first case, the dog was three years old and the owner described complete inability to move the pelvic limbs. The neurological examination revealed paraplegia, postural reactions deficits, normal spinal reflexes and muscle tonus in the hind limbs, pain on palpation in T12-T11 region and loss of deep pain in hind limbs. In the other case, the dog was seven years old and the owner described partial inability to move four limbs. The neurological examination revealed non-ambulatory tetraparesis, postural reactions deficit, normal spinal reflexes in four limbs and pain on palpation in cervical spine. In both cases, the presumptive diagnosis was intervertebral disc disease and surgical treatment was indicated. The dog with thoracolumbar injury died during the anesthesia and the dog with cervical injury was euthanized, after decision of owner. During the necropsy was observed intervertebral disc extrusion between L1-L2 vertebrae in a dog and between C3-C4 vertebrae in the other case with cartilaginous fragments in the spinal canal. Histopathology revealed marked diffuse necrosis with multifocal hemorrhage and cartilaginous emboli.Discussion: Fibrocartilaginous embolic myelopathy is commonly reported in large and giant breed dogs, though also occur in small and medium-sized breeds of dogs. One hypothesis is the pulpous nucleus remains soft for a longer period in large breed dogs, empowering to infiltration in the spinal cord vessels. The intervertebral disc extrusion occurs predominantly in dogs with age between three and six years old, in the cervical, thoracolumbar (T11-L3) and lumbar regions. Chondroid or fibroid degeneration of the intervertebral disc is the most common cause of spinal cord compression in small animals. In chondrodistrophic breed dogs is frequently chondroid degeneration, which the nucleus pulposus moves into the spinal canal through rupture of the annulus fibrosus (extrusion or Hansen type I), causing acute spinal cord compression. The prevalence of fibrocartilaginous embolism in adult and old dogs increase the possibility of predisposing factors, facilitating the injection intravascular of nucleus pulposus material. One of the most accepted theories about the mechanism of fibrocartilaginous emboli into the vessels is due to increase of inside discal pressure and liberation of fibrocartilaginous emboli from nucleus pulposus into the vertebral artery for retrograde flow, reaching the spinal cord by blood flow. The simultaneous occurrence of intervertebral disc disease and the infarction of spinal cord in the proximate region accentuate the hypothesis that the etiology of fibrocartilaginous embolic myelopathy is mechanical into the vessels of the spinal cord.Keywords: neurology, spinal cord, intervertebral disc disease, dogs.

Subarachnoid transplantation of autologous neurogenically induced bone marrow derived mesenchymal stem cells for the treatment of fibrocartilaginous embolic myelopathy in two dogs

The objective of this study was to investigate the effects of autologous neurogenically induced bone marrow-derived mesenchymal stem cells (NIBM-MSCs) in two dogs suspected to have fibrocartilaginous embolic myelopathy (FCEM). Both dogs were paraplegic without deep pain perception (DPP) and tentatively diagnosed by MRI. Autologous NIBM-MSCs (5 × 106) were transplanted into the lumbar subarachnoid space two times with a 21-day interval for each patient. Based on a 21-month follow-up of the treated animals, the transplantation of NIBM-MSCs seems to be promising in subjects with FCEM lacking DPP.

A Review of Fibrocartilaginous Embolic Myelopathy and Different Types of Peracute Non-Compressive Intervertebral Disk Extrusions in Dogs and Cats.

This review discusses terminology, pathological, clinical, and magnetic resonance imaging (MRI) findings, treatment, outcome, and prognostic factors of fibrocartilaginous embolic myelopathy (FCEM), acute non-compressive nucleus pulposus extrusion (ANNPE), and intradural/intramedullary intervertebral disk extrusion (IIVDE). FCEM, ANNPE, and IIVDE have a similar clinical presentation characterized by peracute onset of neurological dysfunction that is generally non-progressive after the initial 24–48 h. Differentiating between these conditions can be challenging, however, certain clinical and imaging findings can help. FCEM can occur in both adult and immature animals, whereas ANNPE or IIVDE have been reported only in animals older than 1 year. In dogs, ANNPE and IIVDE most commonly occur in the intervertebral disk spaces between T12 and L2, whereas FCEM has not such site predilection. In cats, FCEM occurs more frequently in the cervical spinal cord than in other locations. Data on cats with ANNPE and IIVDE are limited. Optimal MRI definition and experience in neuroimaging can help identify the findings that allow differentiation between FCEM, ANNPE, and IIVDE. In animals with ANNPE and IIVDE, the affected intervertebral disk space is often narrowed and the focal area of intramedullary hyperintensity on T2-weighted images is located above the affected intervertebral disk space. In dogs with ANNPE signal changes associated with the extruded nucleus pulposus and epidural fat disruption can be identified in the epidural space dorsal to the affected intervertebral disk. Identification of a linear tract (predominantly hyperintense on T2-weighted images, iso to hypointense on T1-weighted images and hypointense on T2*-weighted gradient recall echo images) extending from the intervertebral disk into the spinal cord parenchyma is highly suggestive of IIVDE. Treatment of FCEM and ANNPE is conservative. Dogs reported with IIVDE have been managed either conservatively or surgically. Prognostic factors include degree of neurological dysfunction (particularly loss of nociception) and disease-specific MRI variables.

ANTEMORTEM DIAGNOSIS AND SUCCESSFUL MANAGEMENT OF NONCOMPRESSIVE SEGMENTAL MYELOPATHY IN A SIBERIAN-BENGAL MIXED BREED TIGER

A 10-yr-old female spayed mixed breed tiger presented for a 9-day history of acute and nonprogressive paralysis of the pelvic limbs. Magnetic resonance imaging revealed a lesion suggestive of fibrocartilaginous embolic myelopathy with regional spinal cord edema, decreased disk signal intensity at L2-L3, and mild intervertebral disk protrusion at L1-L2 and L2-L3. Cerebral spinal fluid analysis showed no overt evidence of infection or neoplasia. Medical therapy was instituted, including corticosteroids and gastroprotectants as well as nursing care and physical therapy. The tiger began showing clinical improvement 2 wk after initiating treatment, progressing to the point where the animal was standing and intermittently walking. Three months after diagnosis, the tiger had regained muscle strength of its hind limbs and walked regularly with improving coordination. This case is the first report of antemortem diagnosis and successful medical management of suspected fibrocartilaginous embolic myelopathy in a large exotic felid.

Percutaneous transplantation of human umbilical cord-derived mesenchymal stem cells in a dog suspected to have fibrocartilaginous embolic myelopathy

The use of human umbilical cord blood-derived mesenchymal stem cells for cell transplantation therapy holds great promise for repairing spinal cord injury. Here we report the first clinical trial transplantation of human umbilical cord (hUCB)-derived mesenchymal stem cells (MSCs) into the spinal cord of a dog suspected to have fibrocartilaginous embolic myelopathy (FCEM) and that experienced a loss of deep pain sensation. Locomotor functions improved following transplantation in a dog. Based on our findings, we suggest that transplantation of hUCB-derived MSCs will have beneficial therapeutic effects on FCEM patients lacking deep pain sensation.

Mechanisms of injury and emergency care of acute spinal cord injury in dogs and cats

To review the literature in regards to the pathophysiology of acute spinal cord injury, and to describe current concepts in regards to patient assessment, diagnostic, and therapeutic measures with a special emphasis on emergency and critical care considerations. Acute spinal cord injury occurs in 2 phases. The primary injury occurs at the time of initial injury and may include intervertebral disk herniation, vertebral fracture or luxation, penetrating injury, and vascular anomalies such as fibrocartilaginous embolic myelopathy. Secondary injury occurs following primary injury and is multifactorial encompassing numerous biochemical and vascular events that result in progression of injury. The diagnosis is based on history and physical examination findings. A neurologic examination should be performed following initial patient assessment and stabilization. Further diagnostics to characterize acute spinal injury include radiographs and advanced imaging modalities such as myelography, computed tomography, or magnetic resonance imaging. Initial treatment should focus on addressing the patient's cardiovascular and respiratory system. Supportive measures to support systemic perfusion are vital to minimizing secondary injury. Specific therapy toward minimizing secondary injury in veterinary medicine remains controversial, especially in regards to the utilization of methylprednisolone. Other therapies are either in need of additional research or have failed to document clinical difference. The prognosis for acute spinal injury is varied and is dependent upon the presence of concurrent trauma, location, and type of primary injury sustained, and extent of neurologic impairment at the time of initial presentation. The etiology of the underlying trauma is of great importance in determining prognosis and outcome. Loss of deep pain is generally accepted as a poor prognostic indicator; however, even these patients can recover depending on their response to treatment.

Therapy by traditional veterinary medicine in a case with canine fibrocartilaginous embolic myelopathy

Therapy by traditional veterinary medicine in a case with canine fibrocartilaginous embolic myelopathy

Fibrocartilaginous Embolic Myelopathy in a Lion (Panthera leo)

A 6-yr-old, captive-born male lion (Panthera leo) with a 3-day history of acute and nonprogressive spastic paraplegia of the hind limbs and flaccid paraplegia of the left forelimb, was submitted for postmortem examination. Before and after the onset of the neurologic signs, neither hematologic nor other significant clinical abnormalities were observed. The only remarkable gross lesion was restricted to the C6-C7 segments of the spinal cord, where a focal and asymmetric enlargement of the cord displaced the nerve roots. On the cut surface, a poorly demarcated dark red hemorrhagic lesion involved the lateroventral funiculi and the ventral horn of the gray matter, exclusively on the left half of the cord. Extensive necrosis, hemorrhages, degeneration of the neuroparenchyma, and several fibrocartilaginous emboli occluding the lumina of intraparenchymal arteries were present within histologic sections of spinal cord. Emboli also were detected within the meningeal vessels. This is the first report of fibrocartilaginous embolic myelopathy occurring in a lion.

The paralyzed cat. Neuroanatomic diagnosis and specific spinal cord diseases.

Practical relevanceNeurological diagnosis in veterinary practice can be very cAlthough gait disturbance is one of the most common neurological presentations in feline medicine, the clinical approach to the paralyzed cat can be challenging. After excluding orthopedic and cardiovascular diseases that may mimic a neurological condition, the clinician has to address a long list of different diseases that may affect the spinal cord and produce paresis.Clinical challengesIn many cases a definitive cause of spinal weakness in cats is difficult to prove. Even when treatable diseases are identified, the prognosis is very much dependent on the severity of the clinical signs and their chronicity. This review sets out to describe the specific approach, diagnosis and management of cats with spinal cord disease and to outline the most common diseases responsible.Patient groupPatients of either gender and all ages and breeds can be affected by spinal cord disease.Evidence baseMany diseases affecting the spinal cord of cats, which include fibrocartilaginous embolic myelopathy, intervertebral disc disease, exogenous spinal cord trauma, spinal cord lymphosarcoma and feline infectious peritonitis, are well described in the literature. Many of these descriptions, however, have been based on case reports or series. While there have been several retrospective studies that describe the characteristics and incidence of these diseases in cats, there are no long term treatment trials or outcome studies to assist with prognostic determinations.

Fibrocartilaginous Embolic Myelopathy in Five Cats

Five cats had clinical signs, radiographic findings, and cerebrospinal fluid analyses consistent with fibrocartilaginous embolic myelopathy. All cats had an acute onset of nonpainful, asymmetrical spinal cord signs (paresis or paralysis of one or more limbs). Magnetic resonance imaging was performed in three cats. On T2-weighted images, an intramedullary lesion was revealed that was hyperintense to normal spinal cord gray matter. On T1-weighted images, the lesion was isointense. Three of the cats were euthanized, and postmortem examination confirmed myelomalacia with intralesional fibrocartilaginous emboli. Two cats survived and were clinically improved within 3 weeks.