What is fibrocartilaginous embolus (FCE)?
FCE is an abbreviation for “fibrocartilaginous embolus/emboli” (“emboli” is the plural of embolus). Fibrocartilage is connective tissue found primarily in the joints. An embolus is material that travels through the circulation and blocks a blood vessel.
"An FCE is the acute death of part of the spinal cord caused by the embolus of fibrocartilaginous material."
Another term for FCE is “fibrocartilaginous embolic myelopathy”, with the word “myelopathy” describing a problem with the spinal cord. An FCE is the acute death of part of the spinal cord caused by the embolus of fibrocartilaginous material.
The material originates in an intervertebral disk or the marrow found within a vertebral body, then travels in the circulation where it blocks arteries or veins. The precise way the material gets into the blood vessels is unknown.
Is this condition more common in some breeds than others? Does age have anything to do with FCE?
Giant and large-breed dogs are most affected, but the condition is not uncommon in miniature schnauzers, Shetland sheepdogs and Yorkshire terriers. It appears that FCE may occur more commonly in males than in females. Miniature schnauzers and shelties are over-represented among these patients. Most patients are young adults between 3 and 5 years old, but the condition has been recorded in dogs as young as 4 months and as old as 10 years of age. However, FCE can occur in any dog.
What causes FCE?
It’s most common for an FCE to occur following a mild trauma or during vigorous exercise, although some cases are reported in dogs that are simply walking. FCE occurs suddenly, and the affected dogs typically cry out in pain. Most often, the pain subsides within a few minutes, and signs of weakness and/or paralysis develop quickly. These dogs are generally stable within 12 to 24 hours.
What are the clinical signs of FCE?
Although dogs with FCE typically have a period of acute pain, it is common for a dog with FCE to be relatively comfortable within a short time. In general, nervous system deficits (such as weakness and paralysis) are localized to one side of the body, and the other side of the body is either mildly affected or completely normal.
Occasionally, the embolic lesion is positioned such that both sides of the dog’s body are affected. The level of the dog’s dysfunction depends on what level of the spinal cord is damaged, and the signs may be as simple as incoordination or as serious as paralysis.
How is FCE diagnosed?
Dogs with FCE are typically diagnosed by findings on a physical exam. Spinal X-rays in affected dogs are usually normal. The most common and best diagnostic test for FCE is magnetic resonance imaging (MRI).
How is FCE treated?
Most dogs who experience FCE are hospitalized in the acute phase so that diagnostic tests can be performed to rule out other causes of acute-onset weakness or paralysis. If the dog cannot walk, then intensive nursing care is needed, including keeping the dog on a padded surface and turning them frequently to prevent pressure sores. It is important to encourage these dogs to move and walk as soon as possible.
"Using assistive devices (e.g., a lightweight harness with a handle along the back, a fabric sling, or a walking cart) can facilitate healing and early restoration of mobility."
There is no specific medical treatment for FCE. Instead, the emphasis is on supportive care and physical assistance. Using assistive devices (e.g., a lightweight harness with a handle along the back, a fabric sling, or a walking cart) can facilitate healing and early restoration of mobility. Physical rehabilitation, including assisted exercises, muscle stimulation, and hydrotherapy on an underwater treadmill, can also help these dogs regain strength and coordination.
Once other causes of weakness or paralysis are ruled out, activity should be encouraged to prevent, or at least minimize, muscle atrophy. Most improvement for these dogs occurs within 3–4 months, but every dog is different.
Do I need to worry about this happening again? Are there any other potential complications?
FCE is unlikely to recur. Depending on the lesion, a dog may have difficulty emptying their bladder, requiring assistance and vigilance to prevent a urinary tract infection. Also, depending on the lesion, the dog may have stool incontinence.
If the clinical signs of FCE progress during the initial phases of the disease, it indicates progressive destruction of the spinal cord that is not reversible and, unfortunately, euthanasia may be indicated.
Recovery from the weakness or paralysis caused by FCE is slow and gradual and often reaches a plateau. Some dogs appear to make a complete recovery. Your veterinary health care team can assist with guidance and support following FCE.
