Myelopathy associated with fibrocartilaginous emboli (FE): review and two suspected cases

Myelopathy secondary to fibrocartilaginous emboli is rarely reported and has been documented antemortem only once. The pathophysiology of fibrocartilaginous emboli lacks consensus, although the role of trauma has been previously entertained.

We reviewed the reported cases of myelopathy secondary to fibrocartilaginous emboli. We extensively evaluated two cases of myelopathy in otherwise healthy individuals using myelography and serial magnetic resonance imaging (MRI). Evaluation for underlying systemic disease was conducted in both cases.

No evidence of infectious, autoimmune, inflammatory, or neoplastic disease was found in either patient. Furthermore, no other lesions were found in the neuroaxis. Findings on serial MRIs were consistent with vascular lesions thought to be venous strokes.

We report two cases of acute myelopathies associated with heavy lifting, in otherwise healthy young men. Serial MRI studies in each case demonstrated lesions consistent with venous infarcts. We postulate that migration of disc material into the perivertebral venous system was the result of increased intervertebral disc pressure and simultaneous excessive Valsalva associated with heavy lifting. We further postulate that this may be a more prevalent cause of acute myelopathy than previously recognized.