Fibrocartilaginous embolism (FCE) of the spinal cord is an ischemic myelopathy caused by rupture of the intervertebral disc and subsequent entrance of the nucleus polposus material into the nearby vasculature. However, responsible disc lesions frequently cannot be determined, which may cause diagnostic difficulty.
A 63-year-old man suddenly felt a strange sensation in the lower limbs and noticed that he could not walk. The patient was brought to our hospital, where he was hospitalized. On neurological examination, his proprioception and vibratory sense were disturbed in the lower limbs. Spine magnetic resonance imaging (MRI) revealed a hyperintense cord lesion located at the C4–5 vertebral level of the posterior spinal artery region on diffusion-weighted sequence. He was diagnosed as having spinal cord infarction and treated with antiplatelet medication. Follow-up MRI was performed 5 days later, which displayed a collapsed C3/4 disc and a defected C4 vertebral body that were not evident on earlier MRI. These findings suggested the disc lesion was active and responsible for the infarction, leading to the diagnosis of FCE. The patient gradually improved and had no gait difficulty at the time of discharge.
In the presented case, MRI did not reveal the responsible disc lesion when the diagnosis of spinal cord infarction was made; however, it became evident 5 days later. Although such a disc signal change within several days has not been described as a clue suggesting FCE, follow-up MRI with a relatively short interval may elucidate the responsible lesion and correct diagnosis.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
The utility of diffusion-weighted imaging in patients with spinal cord infarction: difference from the findings of neuromyelitis optica spectrum disorder
BMC Neurology Open Access 11 October 2022
Subscribe to Journal
Get full journal access for 1 year
We are sorry, but there is no personal subscription option available for your country.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Moore BJ, Batterson AM, Luetmer MT, Reeves RK. Fibrocartilaginous embolic myelopathy: Demographics, clinical presentation, and functional outcomes. Spinal Cord. 2018;56:1144–50.
Mateen FJ, Monrad PA, Hunderfund AN, Robertson CE, Sorenson EJ. Clinically suspected fibrocartilaginous embolism: Clinical characteristics, treatments, and outcomes. Eur J Neurol. 2011;18:218–25.
AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G, et al. Fibrocartilaginous embolism: A comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. J Spinal Cord Med. 2016;39:146–54.
Tosi L, Rigoli G, Beltramello A. Fibrocartilaginous embolism of the spinal cord: A clinical and pathogenetic reconsideration. J Neurol Neurosurg Psychiatry. 1996;60:55–60.
Davis GA, Klug GL. Acute-onset nontraumatic paraplegia in childhood: Fibrocartilaginous embolism or acute myelitis? Childs Nerv Syst. 2000;16:551–4.
Raghavan A, Onikul E, Ryan MM, Prelog K, Taranath A, Chennapragada M, et al. Anterior spinal cord infarction owing to possible fibrocartilaginous embolism. Pediatr Radio. 2004;34:503–6.
Duprez TP, Danvoye L, Hernalsteen D, Cosnard G, Sindic CJ, Godfraind C, et al. Fibrocartilaginous embolization to the spinal cord: Serial MR imaging monitoring and pathologic study. AJNR Am J Neuroradiol. 2005;26:496–501.
Bansal S, Brown W, Dayal A, Carpenter JL. Posterior spinal cord infarction due to fibrocartilaginous embolization in a 16-year-old athlete. Pediatrics. 2014;134:e289–92.
Weidauer S, Nichtweiss M, Lanfermann H, Zanella FE. Spinal cord infarction: MR imaging and clinical features in 16 cases. Neuroradiology. 2002;44:851–7.
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: Aaetiology, clinical syndromes and imaging features. Neuroradiology. 2015;57:241–57.
Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: Clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006;63:1113–20.
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis. 2009;27:493–501.
Zalewski NL, Rabinstein AA, Krecke KN, Brown RD Jr, Wijdicks EFM, Weinshenker BG, et al. Characteristics of spontaneous spinal cord infarction and proposed diagnostic criteria. JAMA Neurol. 2019;76:56–63.
Kuek DKC, Chung SL, Zishan US, Papanikitas J, Yanny S, Meagher T, et al. Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia. Spinal Cord Ser Cases. 2019;5:92.
Morshid A, Jadiry HA, Chaudhry U, Raghuram K. Pediatric spinal cord infarction following a minor trauma: A case report. Spinal Cord Ser Cases. 2020;6:95.
Draganich C, Wenzel LR. Fibrocartilagenous embolism case series: Is it a zebra? Spinal Cord Ser Cases. 2021;7:28.
Griffith JF, Guglielmi G. Vertebral fracture. Radio Clin North Am. 2010;48:519–29.
Ozgen S, Pait TG, Cağlar YS. The V2 segment of the vertebral artery and its branches. J Neurosurg Spine. 2004;1:299–305.
The author declares no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Kobayashi, M. Fibrocartilaginous embolism of the posterior spinal artery: A case report regarding the responsible intervertebral disc on magnetic resonance imaging. Spinal Cord Ser Cases 8, 10 (2022). https://doi.org/10.1038/s41394-022-00477-y