Fibrocartilaginous embolism (FCE) is a rare type of embolism (sudden blocking of an artery) that occurs in the spinal cord. FCE occurs when materials that are usually found within the vertebral disc of the spine enter into the nearby vascular system (veins and arteries) and block one of the spinal cord vessels. The signs and symptoms of FCE often develop after a minor or even unnoticed “triggering event” such as lifting, straining, or falling. Symptoms of FCE may include neck and/or back pain, progressive muscle weakness, and paralysis.

The exact underlying cause of FCE is poorly understood. Most cases occur sporadically in people with no family history of the disease. Diagnosis is based on imaging of the spinal cord and ruling out other causes of a blockage of the vascular system within the spinal cord. Treatment is generally focused on preventing possible complications and improving quality of life with medications and physical therapy.

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.

Signs and symptoms of fibrocartilaginous embolism (FCE) include:

• Sudden neck and/or back pain
• Progressive muscle weakness
• Bladder and/or bowel dysfunction
• Paralysis

In the majority of cases, FCE develops after a minor or even unnoticed "triggering event" such as a minor head or neck injury or heavy lifting. The amount of time between the "trigger" and the onset of symptoms varies from minutes to days, with the average onset of symptoms being 2.4 days after the triggering incident.

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.

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.

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