What Is FCE (Fibrocartilaginous Embolism) In Dogs?
FCE, or Fibrocartilaginous Embolism, in dogs is a rare occurrence similar to a spinal stroke in humans. It happens when a fragment of fibrocartilage from within a spinal disc enters the bloodstream, blocking a spinal artery and causing a lack of blood flow to part of the spinal cord.
Typically, FCE strikes suddenly while a dog is engaged in activities like play or even simple walking. The onset is marked by a brief cry of pain, followed by neurological symptoms such as sudden weakness, difficulty walking, and in severe cases, paralysis.
Although the initial pain usually diminishes quickly, the neurological effects may persist. FCE can affect any part of the spine and may impact one or both sides of the body. In cases where the cervical region is affected, all four legs may experience weakness or paralysis, severely hindering the dog’s mobility. When the lumbar area is involved, only one or both hind limbs may be affected.
Given the sudden onset and severity of symptoms, FCE is considered a veterinary emergency, requiring immediate attention and intervention.
Symptoms and Types
The symptoms of FCE (Fibrocartilaginous Embolism) in dogs typically manifest suddenly while the dog is engaged in normal activities like walking or playing. These symptoms may include:
- Vocalization in response to acute pain, which usually diminishes quickly (often within minutes)
- Collapsing
- Weakness (paresis) affecting one or more limbs
- Lameness
- Knuckling of one or more paws
- Dragging of one or more legs due to the loss of sensation and movement (paralysis)
- Occasional inability to urinate
- Occasional fecal incontinence
Causes
FCE (Fibrocartilaginous Embolism) in dogs occurs when a fragment of fibrocartilage from within one of the intervertebral discs becomes dislodged suddenly and enters the bloodstream, where it becomes lodged within a spinal artery. The exact cause of the migration of fibrocartilage or its entry into the bloodstream remains unknown.
While all breeds of dogs are susceptible to FCE, larger breeds such as Labrador Retrievers and Bernese Mountain Dogs are more predisposed. Conversely, smaller breeds like Miniature Schnauzers, Yorkshire Terriers, and Shetland Sheepdogs also exhibit a higher incidence of FCE despite their size.
Most dogs experiencing FCE are typically middle-aged, ranging from 3 to 6 years old. FCE occurrences are more prevalent in dogs engaged in high-intensity activities like playing Frisbee® or those who have experienced traumatic injuries. However, even dogs engaged in regular walking can develop FCE.
Diagnosis
To diagnose FCE (Fibrocartilaginous Embolism) in dogs, veterinarians typically initiate with a comprehensive physical examination, followed by a neurological assessment to evaluate the dog’s gait, pain response, and reflexes. Through these evaluations, veterinarians can pinpoint the affected section of the spine.
Several diagnostic tests may be recommended to confirm an FCE diagnosis:
- X-rays of the spine often yield normal results since the fibrocartilage forming the embolism is not visible on X-rays.
- Magnetic Resonance Imaging (MRI) serves as the preferred method to diagnose FCE accurately. However, due to limited availability, finding a veterinary hospital equipped with an MRI machine may be challenging. An MRI captures multiple images of the spinal cord while the dog is under general anesthesia.
- Myelography, a contrast study, involves injecting dye into the spinal canal followed by X-rays of the spine. The dye should outline the spinal cord, and localized swelling may indicate the presence of an FCE. However, myelography does not provide a definitive diagnosis but can offer supportive evidence.
- Spinal fluid analysis may be suggested to rule out spinal fluid infections. Although spinal fluid is typically normal in dogs with FCE, occasional presence of inflammatory cells and excess protein may be observed in the absence of infection.
Treatment
Treating FCE (Fibrocartilaginous Embolism) in dogs does not involve specific medications or surgical interventions. Instead, the focus is on physical therapy and supportive care to aid the dog’s recovery.
If the FCE results in the loss of the dog’s ability to urinate, it’s essential for a veterinary professional to regularly express the dog’s bladder to prevent rupture. Pet parents may also be trained to perform this task. As the dog regains the ability to stand, using a harness and sling can provide support and encourage walking, facilitating recovery.
Referral to a veterinarian specializing in physical therapy can be beneficial for the dog’s rehabilitation. Physical therapists may employ techniques such as massaging the affected area, neuromuscular electrostimulation to stimulate muscles, and hydrotherapy using an underwater treadmill to encourage limb usage and enhance recovery. These interventions help the dog regain function and confidence in walking again.
Living and Management
Recovering from FCE (Fibrocartilaginous Embolism) is a gradual process for dogs. Improvement typically begins within 14 days after the onset of FCE symptoms, but it may take 3 to 4 months for full recovery in some cases. The extent of recovery depends on the severity of neurological deficits. Dogs with paralysis in one or more limbs face more significant challenges compared to those experiencing knuckling but still retaining feeling in their limbs. Regular neurological exams are necessary to monitor reflexes and pain response. Dogs without paralysis generally have a better prognosis.
Recovery outcomes vary among dogs affected by FCE. While some dogs fully regain their mobility, others may continue to experience nerve deficits, leading to abnormal walking patterns in the affected limbs. Some dogs may also exhibit fecal incontinence or require bladder expression multiple times a day. If a dog’s quality of life deteriorates with no signs of improvement 14 days after the FCE occurrence, euthanasia might be considered.
Fortunately, the likelihood of experiencing another FCE in the future is low once a dog has already had one.