Fibrocartilaginous Embolism Presenting as Isolated L2-3 Radiculopathy without Spinal Cord Infarction

Area of Science:

• Neurology
• Vascular Medicine
• Rehabilitation Medicine

Background:

• Lumbosacral radiculopathy, characterized by back pain and lower limb weakness, is common in rehabilitation.
• Fibrocartilaginous embolism (FCE) is an infrequent yet critical vascular etiology of radiculopathy, resulting from disc material entering spinal vasculature and causing infarction.

Purpose of the Study:

• To report the first case of isolated L2-L3 radiculopathy caused by fibrocartilaginous embolism (FCE) without spinal cord infarction.
• To describe the diagnostic findings and conservative treatment outcomes for this rare presentation of FCE.

Main Methods:

• Case presentation of a 54-year-old female with acute right lower limb weakness and sensory impairment.
• Diagnostic imaging included lumbosacral MRI revealing vertebral and nerve root infarctions, and CT angiography showing arterial occlusion.
• Electromyography confirmed L2-L3 radiculopathy; treatment involved aspirin and physical therapy.

Main Results:

• Lumbosacral MRI demonstrated infarctions in the L3 vertebral body, right L3 dorsal root ganglion, and paraspinal muscles.
• CT angiography identified embolic occlusion of the right third lumbar artery.
• Conservative treatment led to improvement in motor weakness and electromyographic amplitudes.

Conclusions:

• Fibrocartilaginous embolism can cause isolated lumbosacral radiculopathy without evidence of spinal cord infarction.
• Conservative management, including aspirin and physical therapy, can be effective for FCE-induced radiculopathy.
• This case expands the understanding of FCE's clinical manifestations and emphasizes the importance of considering vascular causes in radiculopathy.