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Fibrocartilaginous
Embolization
Spinal cord
fibrocartilaginous embolization is caused by a small fragment of intervertebral
disc material entering the spinal cord’s vascular system via the tissues
attached to the intervertebral disc (see illustration below). Embolization is
the sudden blocking of an artery by a clot of foreign material (an embolus). The
tiny fragment of intervertebral disc material (embolus) results in varying
degrees of damage depending on the portion of the cord supplied by the embolized
blood vessel. Thus, the clinical signs are variable.
Fibrocartilaginous
embolization of the spinal cord is the functional equivalent of a stroke to the
spinal cord rather than to the brain. The events are acute, nonprogressive, and
occur without any prior signs or warnings. Because emboli can occur in any
portion of the cord, clinical signs can involve the rear limbs, all four limbs,
one side of the body, or only one limb. The syndrome is not painful but can
result in paralysis. After the initial spinal cord shock subsides, one side of
the body frequently remains worse or is slower to show improvement.
![[6K GIF] - Fibrocartiliginous Embolization Fig 1,2](fibroscartiliginousembolizationfig12.gif)
In general, if deep pain
perception is intact to the paralyzed limb(s), recovery will begin in two to
three weeks with most clinical function restored by four months. In most cases,
once the diagnosis and degree of clinical damage is ascertained, an accurate
prognosis can be made.
Diagnosis
A tentative diagnosis of a
fibrocartilaginous embolism is made based on history and neurologic examination.
Radiographs (x-rays) are evaluated to ascertain the presence of degenerative
discs and may outline other abnormalities in the spine including fractures and
dislocations. A definitive diagnosis may require a myelogram (contrast dye study
of the spine). Spinal cord swelling may be seen with a myelogram immediately
after the embolus causes an infarction (a localized area of dead cells produced
by occlusion of the arterial supply to that area) (see Fig. 3). If several days
have passed since the onset of clinical signs, the myelogram will be normal.
Other findings with a myelogram may include intervertebral disc extrusions,
tumors, fractures, hematomas, or hemorrhage.
Treatment
Individuals experiencing
an acute episode of fibrocartilaginous embolism are immediately treated once the
diagnosis is confirmed. Intensive medical therapies are of value only during the
first 24 to 48 hours after the spinal cord damage has occurred. Medications used
include corticosteroids to relieve spinal cord swelling and to prevent
collateral damage. Surgery is not indicated in the treatment of spinal cord
infarction. After initial medical management, intensive nursing care and
physical therapy are required. The goal is to maintain muscle tone while the
spinal cord tissue heals.
Prognosis
The prognosis in cases of
fibrocartilaginous embolization depends on many factors:
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The severity of
neurologic dysfunction
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The amount of disc
material that has embolized
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The degree of
accompanying spinal cord swelling
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The location of the
spinal cord infarction
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The overall physical
condition of the patient
In general, the ability to
perceive deep pain in the affected limb(s) and tail remain the major prognostic
indicator. Even if paralysis is complete, the perception of deep pain remains
the key to determining if permanent damage has occurred. This means that, even
if paralysis has occurred, if the conscious perception of deep pain is intact a
functional recovery is anticipated. The time required for recovery and the
degree of neurologic improvement are quite variable. Diligent physical therapy
and good nursing care are important for recovery.
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