Largest canine fibrocartilaginous embolic myelopathy (FCE) case series

Vet Record 2016

Clinical characteristics of canine fibrocartilaginous embolic myelopathy (FCE): a systematic review of 393 cases (1973–2013)

K. A. Bartholomew BSA, K. E. Stover BS, N. J. Olby Vet MB, PhD, MRCVS, DACVIM (Neurology), S. A. Moore DVM, DACVIM (Neurology)

Background
Fibrocartilaginous embolic myelopathy (FCE) is a cause of acute spinal cord infarction in dogs, resulting from embolization of fibrocartilage into spinal cord vasculature. It is associated with a sudden onset of myelopathy, often non-painful. This study aimed to systematically review 393 cases (322 previously reported and 71 newly identified) to clarify clinical features, natural history, and recovery rates, particularly in severe cases lacking nociception.

Methods
A systematic review was conducted using data from PubMed and institutional records. Inclusion criteria focused on confirmed or presumptive FCE diagnoses based on clinical or postmortem findings. Data were analyzed descriptively to outline signalment, clinical presentation, imaging results, cerebrospinal fluid (CSF) findings, and outcomes.

Results
Signalment: FCE was more common in middle-aged, large-breed dogs (30% of cases) and miniature schnauzers, with males slightly overrepresented (male:female ratio ~1.5:1).

Neuroanatomical Localization: The T3-L3 spinal region was the most commonly affected (33.1%).

Imaging and CSF Findings: MRI frequently revealed T2 hyperintensity (90.6%), while CSF analysis was normal in 48.1% of cases. Elevated TNCC and protein levels were seen in some cases.

Outcomes: Among 261 cases with follow-up, 85% regained unassisted ambulation (median time: 14 days). However, severe cases with absent nociception had a poorer prognosis, with only 10% recovering ambulation.

Limitations
The retrospective nature and heterogeneous data sources introduced biases.
Limited follow-up data for severely affected cases constrained conclusions about recovery in this subgroup.
Diagnostic overlap with other conditions (e.g., acute non-compressive nucleus pulposus extrusion) might have influenced results.

Conclusions
FCE typically presents as an acute, non-painful myelopathy, with a good to excellent prognosis for recovery of ambulation in most cases. However, the prognosis for severely affected dogs remains unclear, highlighting the need for prospective studies to better characterize outcomes and treatment efficacy in this population.

Neuroanatomical localisation for dogs presenting with fibrocartilaginous embolic myelopathy (FCE). Information was available in 393 cases. A T3-L3 myelopathy was the most common clinical presentation, with an L4-S3 localisation also frequently observed. Occasionally, multifocal signs were reported

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