FIBROCARTILAGINOUS EMBOLI (FCE)
Relevant Anatomy .
The spine is made up of a chain of bones called vertebrae that keep the spinal cord protected. There is intervertebral discs between each of these boney vertabra.
The disc provides cushioning between the vertebral bodies of the vertebrae. They also allow for flexibility of the spine so the back can move efficiently and without friction. It is made up of the outer fibrous annulus fibrosis, and a soft inner nucleus pulposus which has a jelly like consistency. The vertebra are joined above and below with continuous ligaments. The ligament above the discs (dorsal ligament) is quite sensitive, comprised of many nerves.
The spinal cord sits inside the chain of vertbra (the vertabral column). The spinal cord needs blood to function like other organs in the body. This is supplied by a network of spinal arteries along the body.
The three relevant bits of anatomy in FCE are the jelly like middle of the intervertabral disc (nucleus pulposus), the spinal cord and the spinal arteries.
What is an FCE?
FCE is caused by a small piece of nucleus pulposus breaking off and entering a narrow spinal artery which causes a local blockage and a small embolism. This in turn causes a small part of the spinal cord to lose blood supply and die. It is not a painful condition but can cause a significant loss of function. It is still not known how this piece of disc material is able to enter the blood supply.
Signs of FCE
The signs of FCE are very sudden. The pet can be normal one minute and then abnormal the next.
The typical signs of FCE are weakness or paralysis of one leg, both hind legs or all four legs. Signs can worsen in the first 24 hours but there is no deterioration after that. One of the telltale signs of FCE is the lack of pain that is often associated with other diseases of the spine.
Which dogs are affected by FCE?
It is possible for any dog to suffer from FCE but is more common in giant breed dogs.
The dogs that are more prone to intervertabral disc disease (Basset hounds and Dachshunds) are unlikely to have a FCE episode.
It can happen at any age but young adult dogs aged 3-6 years are at higher risk.
In general diagnosis of FCE is a process of ruling out the other most likely cause of sudden weakness or paralysis - intervertabral disc disease (or a "slipped disc"). To rule out disc disease xrays, myelogram, CT or MRI may be required. One of the big differences is disc disease is usually very painful where an FCE does not cause any pain. There are techniques to visualise a FCE problem on MRI but these are not readily available so a diagnosis of FCE remains the most likely when all other causes of paralysis have been ruled out.
Will my dog get back to normal?
This is a difficult thing to predict. One thing to bear in mind is that pets with FCE don't worsen after the first 24 hours. One study showed that 3 out of 4 dogs showed some improvement after the initial event. Most pets get maximum improvement after 3 weeks but some can take months to reach their full potential.
There are no known conventional treatments.
Alternative treatments and rehabilitation have shown promise but require more studies to prove their effectiveness,
Conservative treatments offered by Balance Vet Rehab that may be beneficial for these pets include:
Simple exercises which can be performed up to three times daily are an affordable way for pets with FCE to return to normal function.
Fibrocartilaginous embolism in 75 dogs: clinical findings and factors influencing the recovery rate
The underwater treadmill can be helpful in restoring normal gait after the disability caused by fibrocartilaginous embolism.
Fibrocartilaginous embolism in 75 dogs: clinical findings and factors influencing the recovery rate G. Gandini