Cuello Juan P, Ortega-Gutierrez Santiago, Linares Guillermo, Agarwal Sachin, Cunningham Alyson, Mohr Jay P, Mayer Stephan A, Marshall Randolph S, Claassen Jan, Badjatia Neeraj, Elkind Mitchel S V, Lee Kiwon
*Department of Neurology, Division of Neurocritical Care †Division of Stroke, Columbia University College of Physicians and Surgeons, New York, NY.
J Spinal Disord Tech. 2014 Dec;27(8):E276-81. doi: 10.1097/BSD.0000000000000115.
Fibrocartilaginous embolism (FCE) is an uncommon cause of myelopathy that should be considered after more common causes have been ruled out.
This article presents a case report of a 50-year-old man with acute myelopathy attributed to FCE and summarizes the clinical features of the disease by analyzing all of the published evidence.
Two computerized literature searches (MEDLINE-Pubmed, EMBASE, the Cochrane Library) were performed. The search term used was "Fibrocartilaginous embolism." No language restrictions were applied. All articles were evaluated and key data were extracted according to predefined criteria: patient's age, year of publication, localization of the embolism and type of vascular syndrome, clinical outcome, and time to death in the fatal cases.
Fifty-two cases (39 biopsy proven and 13 clinically diagnosed) were found in the literature. Median age at presentation was 37 years (interquartile range, 19-53) and 56% were women. Median progression of symptoms was 6 hours (interquartile range, 5-60 h), predominantly affecting the cervical spine (48%) by an arterial embolic source (56%).
FCE is an unusual cause of spinal cord and cerebral ischemia with unknown incidence. Implementation of diagnostic imaging techniques and initial management of acute spinal disorders care in intensive care units might increase the incidence of disease antemortem. FCE should be considered in the differential diagnosis of ischemic spinal cord injury when no other causes can be identified and especially when the onset is progressive over several hours.
纤维软骨栓塞（FCE）是脊髓病的一种罕见病因，在排除更常见病因后应予以考虑。
本文报告一例50岁男性因FCE导致急性脊髓病的病例，并通过分析所有已发表的证据总结该病的临床特征。
进行了两次计算机文献检索（MEDLINE-Pubmed、EMBASE、Cochrane图书馆）。使用的检索词为“纤维软骨栓塞”。未设语言限制。根据预先定义的标准对所有文章进行评估并提取关键数据：患者年龄、发表年份、栓塞部位和血管综合征类型、临床结局以及致命病例的死亡时间。
文献中发现52例病例（39例经活检证实，13例临床诊断）。发病时的中位年龄为37岁（四分位间距，19 - 53岁），56%为女性。症状的中位进展时间为6小时（四分位间距，5 - 60小时），主要影响颈椎（48%），动脉栓塞源占56%。
FCE是脊髓和脑缺血的一种不常见病因，发病率未知。在重症监护病房实施诊断性成像技术和急性脊柱疾病的初始管理可能会增加生前疾病的发病率。当无法确定其他病因，尤其是发病在数小时内呈进行性时，在缺血性脊髓损伤的鉴别诊断中应考虑FCE。
