Embolism
Question Received:
Response:
Can you give me any information on fibrocartilagenous embolism in humans?
19th April 2001
In humans this is a rare condition in which fragments of fibrocartilagenous material – thought to be derived from the vertebral column - enter the blood stream and lodge in blood vessels, particularly those supplying the spinal cord (Moorhouse et al, 1992). In half the cases embolization is both arterial and venous, and in the remaining half purely arterial (Toro et al, 1994). Less than 50 cases have been reported in the medical literature, but it appears that females are more at risk than males, and that the cervical region of the spinal cord is most commonly affected followed by the lumbar region (Ho, Gorell, and Hayden, 1980; Toro et al, 1994). Most fibrocartilagenous emboli appear to be of nucleus pulposus origin (ie: the material at the center of an intervertebral disc) and are released into small blood vessels following trauma (Barz and Majerowitsch, 1986). The risk of the emboli spreading is enhanced if there is increased intra-abdominal or intra-thoracic pressure (Budka, Perneczky, and Pusch, 1979). However, full understanding of the pathogenesis is still lacking (Bots et al, 1981).The result of the embolism is that parts of the spinal cord are deprived of their blood supply and degenerate, with great loss of function (for example the sudden onset of paraplegia or quadriplegia) and in many cases death some days later.
Generally the emboli are found only at post mortem (Kestle et al, 1989; Bockenek et al, 1990), although modern imaging techniques such as magnetic resonance imaging (MRI) have the capability of revealing the emboli while the patient is still alive (Davis and Klug, 2000).
References
Barz, H., and Majerowitsch, B. (1986) [Myelomalacia caused by embolism of the substantia gelatinosa in the vertebral column and spinal cord arteries]. [Article in German] Zentralblatt fur Allgemeine Pathologie und Pathologische Anatomie, 131(2), 119-125.
Bockenek, W.L., Bach, J.R., Alba, A.S., and Cravioto, H.M. (1990) Fibrocartilaginous emboli to the spinal cord: a case report. Archives of Physical Medicine and Rehabilitation, 71(10), 754-757 (Sep).
Bots, G.T., Wattendorff, A.R., Buruma, O.J., Roos, R.A., and Endtz, L.J. (1981) Acute myelopathy caused by fibrocartilaginous emboli. Neurology, 31(10), 1250-1256 (Oct).
Budka, H., Perneczky, A., and Pusch, S. (1979) Infarction of the spinal cord in the posterior spinal arterial supply area as a result of intervertebral disc embolism. [Article in German] Wiener Klinische Wochenschrift, 91(17), 578-583 (Sep 14).
Davis, G.A., and Klug, G.L. (2000) Acute-onset nontraumatic paraplegia in childhood: fibrocartilaginous embolism or acute myelitis? Childs Nervous System, 16(9), 551-554 (Sep).
Ho, K.L., Gorell, J.M., and Hayden, M.T. (1980) Fatal spinal cord infarction caused by fibrocartilaginous embolization of the anterior spinal artery. Human Pathology, 11(5), 471-475 (Sep).
Kestle, J.R., Resch, L., Tator, C.H., and Kucharczyk, W. (1989) Intervertebral disc embolization resulting in spinal cord infarction. Case report. Journal of Neurosurgery, 71(6), 938-941 (Dec).
Moorhouse, D.F., Burke, M., Keohane, C., and Farrell, M.A. (1992) Spinal cord infarction caused by cartilage embolus to the anterior spinal artery. Surgical Neurology, 37(6), 448-452 (Jun).
Toro, G., Roman, G.C., Navarro-Roman, L., Cantillo, J., Serrano, B., and Vergara, I. (1994) Natural history of spinal cord infarction caused by nucleus pulposus embolism. Spine, 19(3), 360-366 (Feb 1).