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What is Fibrocartilaginous Embolism?

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.

REFERENCES

Darryl L. Millis, MS, DVM, DACVS, DACVSMR, CCRP
Professor of Orthopedic Surgery & Director of Surgical Service

Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP
Diplomate of the American Academy of Pain Management, is a a founder and past-president of the International Veterinary Academy of Pain Management.

Janet B. Van Dyke, DVM
Diplomate American College of Veterinary Sports Medicine and Rehabilitation, CCRT, CEO

Ludovica Dragone, DVM, CCRP
Vice President of VEPRA, Veterinary European of Physical Therapy and Rehabilitation Association.

Andrea L. Henderson, DVM, CCRT, CCRP
Resident, Canine Sports Medicine and Rehabilitation

Steven M.Fox, MS, DVM, MBA, PhD
President Securos. Inc

 

What causes Fibrocartilaginous Embolism in Dogs and are there certain breeds at risk?

Unfortunately, this is a question that we cannot answer. No dietary, environmental, or inherited factors, nor any underlying diseases have been identified that predispose to fibrocartilaginous embolism FCE in the majority of dogs. Miniature schnauzers with hyperlipidemia (an inherited tendency to develop high blood fat) and Shetland sheepdogs with hypothyroidism do seem to be predisposed to Fibrocartilagenous Embolism FCE; these dogs may have a slightly different condition from regular FCE.

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 embolism 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.

Fibrocartilaginous Embolism FCE spinal stroke
Fibrocartilaginous Embolism FCE spinal stroke

Signs and Symptoms of Fibrocartilaginous Embolism in Dogs

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.

Small dogs can:

  • Sudden, severe pain, dog may cry out at time of injury
  • Pain may subside after few minutes to hours
  • Paresis (signs of weakness or partial paralysis)
  • ParalysisLack of pain response (after initial pain response)
  • Dog may stabilize within 12-24 hours
  • Wobbly, uncoordinated or drunken gait (ataxia)

Fibrocartilaginous Embolism – The importance of a proper diagnosis process

You will need to provide a thorough history of your dog’s health leading up to the onset of symptoms, the type of activities your dog engages in, and any injuries that you suspect to have recently occurred. Your veterinarian will rule out other causes, such as spinal tumor, intervertebral disc disease, or fracture before settling on a diagnosis. The above mentioned conditioned are very painful, therefore, a lack of pain can be indicative of an embolism in the spinal cord. Keep in mind that though there may be a lack of pain, the condition can be progressive and may affect long-term damage to the spine and neurological system. Immediate and supportive care is essential.

Routine laboratory test results, such as urinalysis and complete blood counts, are usually unremarkable. A sample of cerebral spinal fluid (CSF) may be taken for analysis, and a sample of blood from the veins and arteries of the spinal cord may show microscopic fragments of fibrocartilage. Radiographic imaging studies may help in diagnosis. Apart from routine radiography, magnetic resonance imaging (MRI) remains the best diagnostic technique for viewing the spinal cord. In the later stage of fibrocartilaginous embolic myelopathy, swelling may be present at the site of the blockage.

The importance of Rehabilitation and Physiotherapy for Dogs with Fibrocartilaginous Embolism

As a non-surgical disease of the spinal cord, rehabilitation has a huge role to play in managing dogs diagnosed with FCE. Following the assessment of our animal rehabilitation practitioner, we will custom design a treatment plan unique for them. Maintenance of physical function and prevention of secondary compensatory changes is vital to your dog making good progress throughout the rehabilitation process. The level to which a patient is affected by the FCE will vary from dog to dog. Furthermore, the rate at which a patient progresses will dictate the necessary adjustments to the rehabilitation plan. Ongoing re evaluation is essential to allow an effective and appropriate treatment course.

Rehabilitation Aims

In the initial stage following diagnosis, the aims are as follow:

  • Maintain soft tissue flexibility
  • Prevent muscle spasm
  • Provide sensory stimulation
  • Provide supported means of mobility

Depending on your dogs progress, the aims might then progress to:

  • Improving core stability
  • Improving body awareness and coordination
  • Providing home care management advice

6 weeks on from diagnosis your chartered physiotherapist would aim to:

  • Strengthen core stability
  • Improve gait pattern
  • Increase cardiovascular fitness
  • Return to normal functional activities

Rehabilitation Options

Correct positioning, massage and stretches can be implemented in the early days. sensory stimulation techniques complement the healing at this stage. Muscle stimulation is invaluable to maintain “at risk” muscle groups whilst your dog might be recumbent. As your dog improves, an appropriate exercise plan can be used to assist in gait re-education, strengthening and promote balance. In the latter stages once your dog is recovering well, core stability exercises need advancing as does general cardiovascular fitness. Advice regarding assisting with every day activities will be given as can injury prevention.

Below is a sample of FCE Rehabilitation.

TimelinePhysiotherapy AimsRehabilitation Therapy options
Week 0 to 2Reduce potential risk of soft tissue trauma
  • Correct positioning
  • Soft tissue massage and stretches
Reduce muscular guarding
  • Electrotherapy – laser
  • Soft tissue massage
  • Heat therapy
Increase sensory input and motor activity
  • Neuromuscular stimulation
  • Sensory techniques eg brushing, tapping
Possibly gait re-education according to deficits
  • Hydrotherapy
  • Under water treadmill
Week 2 to 4Improve Core stability
  • Home exercise program
  • Neuromuscular electrical stimulation
  • Hydrotherapy
  • Under water treadmill
Increase sensation and awareness of body positionProprioceptive based home exercise program
Maintain soft tissue length and flexibility
  • Home exercise program
  • Passive movements and stretches
Management at home
  • Exercise restriction
  • Advice regarding flooring
  • Advice regarding assisted walking with harness and sling if required
  • Advice regarding cavaletti pole work, gradients, steps and different surfaces
Week 4 to 6Continue as aboveProgression of home exercise program to challenge balance, body awareness and strength
Advice on maintaining controlled exercise when dog feeling better
Week 6 to 12Increase exercise toleranceIncrease exercise level, considering land and water based options.
Continue to increase core stabilityHome exercise program considering land and water based exercises
Week 12 onwardsReturn to full function or establish deficits and advise regarding long term management.Progress to off lead exercise and previous exercise level if appropriate.
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