By Dr. Becker
Today I’d like to discuss a condition called fibrocartilaginous emboli.
A fibrocartilaginous embolism, or FCE for short, is a blockage in a blood vessel in the spinal cord. It’s often referred to as a spinal cord stroke.
The vertebral column is made up of small bones called vertebrae that are joined together by intervertebral discs. The discs function as cushions between the vertebrae and allow the spine to flex. They are round in shape, fibrous on the outside, and contain a gel-like substance on the inside called the nucleus pulposus.
One of the jobs of the vertebral column is to protect the spinal cord inside it. The spinal cord is similar to a long cable of nerves that sends messages to and from the brain and regulates the body’s reflexes. The spinal cord is fed by a system of blood vessels.
What Causes a Fibrocartilaginous Embolism?
A fibrocartilaginous embolism occurs when a fragment of the nucleus pulposus inside an intervertebral disc escapes into the blood vessel of the spinal cord and causes an obstruction. This affected area of the spinal cord then dies.
Unfortunately, neurologic loss that occurs within the first 24 hours is usually permanent. The good news is the condition isn’t progressive. Any pain usually resolves within 12 to 24 hours. And with immediate treatment, primarily involving very intensive physical therapy, most dogs experience significant recovery.
An FCE typically results from an injury to the spinal cord often caused when a dog jumps or lands awkwardly. Sometimes vigorous exercise can do it. Dog fights, really rough play, or any sort of accidental trauma can also lead to an FCE.
Fibrocartilaginous emboli are rarely seen in cats and occur most often in large and giant breed male dogs, and also miniature Schnauzers and Shelties between three and six years of age. It’s possible an underlying condition common in these breeds called hyperlipidemia, which is a high blood cholesterol level, could be a contributing factor in smaller dogs who acquire the condition.
Symptoms and Diagnosis
Signs of a fibrocartilaginous embolism usually appear suddenly and follow a period of exercise or what otherwise seems like a mild injury or trauma.
Symptoms can include sudden, severe pain that makes the dog cry or yelp, followed by lessening pain after a few minutes or hours; signs of weakness; partial to full paralysis of a rear limb; a wobbly or uncoordinated gait; and lack of a pain response after initial signs of painfulness, yet the dog still can’t use his body normally.
There is no test currently available to absolutely confirm a diagnosis of FCE in a living animal. Your vet will first try to rule out other causes of sudden acute back pain and mobility problems. Other conditions to look for include intervertebral disc disease, a fracture, or a spinal tumor -- all of which can cause considerable pain.
If your pet is no longer in pain, that in itself can be indicative of an FCE. The vet may also take a sample of cerebrospinal fluid, and a sample of blood from the vessels inside the spinal cord may indicate the presence of some fragments of fibrocartilage.
The best imaging technique for a fibrocartilaginous embolism is the MRI, because it can distinguish between an obstruction (which is an embolism) and a compression or swelling of the spinal cord.
Treatment and Care of a Pet with FCE
The recommended treatment for FCE, even with animals with a poor prognosis due to swelling or decreased pain sensation, is to begin immediate and aggressive physical therapy.
Studies show that physiotherapy instituted immediately after diagnosis can have a major influence on recovery. This should include hydrotherapy (walking on an underwater treadmill), as well as acupuncture, laser therapy, neuromuscular electrical stimulation, range of motion exercises, massage, and supplements.
Supplements I recommend for FCE patients include B-vitamins; proteolytic enzymes (including bromelain to reduce systemic inflammation); NAC or N-acetylcysteine (an antioxidant that passes the blood-brain barrier, which can really help scavenge free radicals within the central nervous system); natural vitamin E (which is also an important antioxidant for neurologic health); SOD or superoxide dismutase (another important antioxidant for central nervous system well-being); and ALA or alpha-lipoic acid.
Aggressive treatment of this acute condition can be very rewarding. Implementing an immediate rehabilitation program is your pet’s very best option for a full recovery and a second chance at life.