Abstract
Study design
Retrospective cohort study.
Objectives
To describe the demographics, clinical presentation, and functional outcomes of fibrocartilaginous embolic myelopathy (FCEM).
Setting
Academic inpatient rehabilitation unit in the midwestern United States.
Methods
We retrospectively searched our database to identify patients admitted between January 1, 1995 and March 31, 2016, with a high probability of FCEM. Demographic, clinical, and functional outcome measures, including Functional Independence Measure (FIM) information was obtained by chart review.
Results
We identified 31 patients with findings suggestive of FCEM (52% male), which was 2% of the nontraumatic spinal cord injury population admitted to inpatient rehabilitation. The age distribution was bimodal, with peaks in the second and sixth-to-seventh decades. The most common clinical presentation was acute pain and rapid progression of neurologic deficits consistent with a vascular myelopathy. Only three patients (10%) had FCEM documented as a diagnostic possibility. Most patients had paraplegia and neurologically incomplete injuries and were discharged to home. Nearly half of the patients required no assistive device for bladder management at discharge, but most were discharged with medications for bowel management. Median FIM walking locomotion score for all patients was 5, but most patients were discharged using a wheelchair for primary mobility. Median motor FIM subscale score was 36 at admission and 69 at discharge, with a median motor efficiency of 1.41.
Conclusions
FCEM may be underdiagnosed and should be considered in those with the appropriate clinical presentation, because their functional outcomes may be more favorable than those with other causes of spinal cord infarction.
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Acknowledgements
Funding
This publication was supported by Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS).
Author contributions
AMB was responsible for designing the study protocol, writing the protocol, performing chart review of potential eligible study subjects, extracting and analyzing data of eligible study subjects, interpreting results, drafting and revising the manuscript, and creating Table 2 and the supplemental figure. BJM was responsible for designing the study protocol, writing the protocol, performing chart review of potential eligible study subjects, extracting and analyzing data of eligible study subjects, interpreting results, drafting and revising the manuscript, creating Table 1, and updating the reference lists. MTL was responsible for identifying potential eligible study subjects. RKR was responsible for designing the study protocol, interpreting results, and manuscript revision.
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Moore, B.J., Batterson, A.M., Luetmer, M.T. et al. Fibrocartilaginous embolic myelopathy: demographics, clinical presentation, and functional outcomes. Spinal Cord 56, 1144–1150 (2018). https://doi.org/10.1038/s41393-018-0159-y
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DOI: https://doi.org/10.1038/s41393-018-0159-y
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