National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Fibrocartilaginous embolism


Other Names:
Embolism, fibrocartilaginous
Categories:
Fibrocartilaginous embolism (FCE) is a rare type of embolism (sudden blocking of an artery) that occurs in the spinal cord.[1] 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.[1]

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.[1] 
Last updated: 8/25/2017
Signs and symptoms of fibrocartilaginous embolism (FCE) include:[1][2]
  • 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.[1]
Last updated: 8/25/2017
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.[1][2]

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.[1][2] 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.[1]

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.[2]
Last updated: 8/25/2017
Fibrocartilaginous embolism (FCE) is not known to run in families. Most cases occur sporadically in people with no family history of disease.[1] However, it is possible for people in the same family to share risk factors that increase the likelihood for developing FCE.
Last updated: 8/25/2017
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:[1][2]

Unfortunately, FCE is generally only confirmed with a biopsy, often performed at the time of autopsy.[1] It is thought that FCE may be underdiagnosed and that it may be more common than originally thought.[3]
Last updated: 8/25/2017
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.[1]

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.[2][4] 
Last updated: 8/25/2017
The long-term outlook (prognosis) for people affected by fibrocartilaginous embolism (FCE) was once thought to be extremely poor with little hope for improvement of symptoms. However, more recent research has challenged this assumption. Many researchers now believe that there is a much wider spectrum of the severity and recovery associated with FCE. Researchers also suspect that the length and degree of recovery depends on many factors including:[2][5]
  • The location of FCE along the spinal cord
  • The extent of spinal cord ischemia (restriction of blood supply to organs or tissues)
Last updated: 8/25/2017

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These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

In-Depth Information

  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Fibrocartilaginous embolism. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

  • I had a spinal cord stroke this past summer. My neurologist thinks it may have been a fibrocartilaginous embolism. What might I expect? Will this happen to me again? What is the amount of recovery on average with this type of injury and what caused it? See answer


  1. AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G. Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. J Spinal Cord Med. 2016; 39(2):146-154. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072491/.
  2. Jones DD, Watson RE, Heaton HA. Presentation and Medical Management of Fibrocartilaginous Embolism in the Emergency Department. J Emerg Med. September 2016; 51(3):315-318. https://www.ncbi.nlm.nih.gov/pubmed/27372375.
  3. Han JJ, Massagli TL, and Jaffe KM. Fibrocartilaginous embolism--an uncommon cause of spinal cord infarction: a case report and review of the literature. Archives of Physical Medincine and Rehabilitation. January 2004; 85(1):153-157. http://www.ncbi.nlm.nih.gov/pubmed/14970983.
  4. Mateen FJ, Monrad PA, Hunderfund AN, Robertson CE, and Sorenson EJ. Clinically suspected fibrocartilaginous embolism: clinical characteristics, treatments, and outcomes. European Journal of Neurology. February 2011; 18(2):218-225. https://www.ncbi.nlm.nih.gov/pubmed/20825469.
  5. Alkhachroum AM, Weiss D, Lerner A, and De Georgia MA. Spinal cord infarct caused from suspected fibrocartilaginous embolism. Spinal Cord Series and Cases. May 18, 2017; https://www.ncbi.nlm.nih.gov/pubmed/28546875.