Anterior Spinal Artery Syndrome in a Patient With Multilevel Cervical Disc Disease: A Case Report.

Anterior spinal artery syndrome (ASAS) is a rare form of spinal cord infarction, making its incidence and prevalence difficult to determine. We present the case of a 60-year-old woman with multiple vascular risk factors who experienced a sudden onset of severe lower limb weakness, raising immediate concerns about spinal cord ischemia. Diagnostic evaluations confirmed ASAS, although the exact cause and mechanism of her spinal cord infarction remained undetermined. The potential presence of significant cervical disc disease suggests fibrocartilaginous embolism (FCE) as a possible underlying mechanism, despite the lack of direct evidence. This case underscores the importance of clinical awareness and timely intervention in patients with similar symptoms and vascular risk factors. Early recognition, cause identification, and appropriate management are crucial for improving outcomes in spinal cord ischemia, guiding specific treatment strategies, and potentially preventing recurrence.

Outcome in paraplegic dogs with or without pain perception due to thoracolumbar fibrocartilaginous embolic myelopathy or acute non-compressive nucleus pulposus extrusion.

Background: Fibrocartilaginous embolic myelopathy (FCEM) and acute non-compressive nucleus pulposus extrusion (ANNPE) are common causes of acute spinal cord injury in dogs. Outcome among paraplegic deep pain positive (DPP) and deep pain negative (DPN) dogs with either condition and factors influencing recovery have not been clearly established. Methods: Dogs with thoracolumbar FCEM or ANNPE resulting in paraplegia presenting to university hospitals between 2012 and 2022 were retrospectively included. Diagnosis of FCEM or ANNPE was based on clinical and magnetic resonance imaging findings. Outcome was defined as successful (recovery of independent ambulation) or unsuccessful (non-ambulatory ≥3 months following diagnosis or at the time of death/euthanasia). Logistic regression analysis was performed to investigate associations between clinical or imaging variables and outcome. Results: Thirty-one dogs were included. In total, 14 dogs were initially paraplegic DPP (8 FCEM, 6 ANNPE) and 17 dogs were paraplegic DPN (11 FCEM, 6 ANNPE). Outcome was available for 26 dogs (14 DPP, 12 DPN) with a median follow-up time of 182 days (range 0-2,311) including 2 dogs euthanized at the time of diagnosis; 1 of 12 DPN dogs (8.3%) regained independent ambulation, whereas 9 of 14 DPP dogs (64.3%) regained independent ambulation. DPN dogs had a significantly higher risk of not regaining independent ambulation compared with DPP dogs (OR: 47.40, 95% CI: 2.09-1073.99). No other variables were associated with outcome. Conclusion: While recovery of ambulation was possible, these results confirm that the absence of pain perception is a useful negative prognostic indicator in dogs with severe thoracolumbar FCEM or ANNPE.

Fibrocartilaginous embolism: a rare cause of cervical spine infarction.

Introduction and importance: One of the uncommon causes of ischaemic myelopathy is fibrocartilaginous embolisation, which results from the intersomatic disc nucleus pulposus becoming embolised into the spinal vasculature during Valsalva-like manoeuvres. Case presentation: A 29-year-old female patient presented to the authors' emergency department with general weakness, dizziness, and an inability to move her right hand after a minor trauma. These symptoms deteriorated suddenly until the patient became quadriplegic. The clinical picture and MRI led to a diagnosis of fibrocartilaginous embolism. Clinical discussion: Fibrocartilaginous embolism is a rare cause of spine infarction. There is still little understanding of the underlying cause of FCE. Most cases occur sporadically in people without a family history of the disease, such as the authors' case, and diagnosis is based on imaging of the spinal cord and ruling out other causes of a blockage in the vascular system within the spinal cord, infectious and inflammatory causes. Conclusion: When a practitioner suspects that a patient may have fibrocartilaginous embolism (FCE), they should take the patient's history and do a neurological examination. An MRI is required since it is thought to be the most accurate method of diagnosing FCE.

Fibrocartilaginous Dysplasia of the Proximal Femur in Two Pediatric Patients, Including a Pathologic Fracture in a Patient With McCune-Albright Syndrome.

Fibrocartilaginous dysplasia (FCD) is a variant of fibrous dysplasia that often involves the proximal femur in young adults. It has a similar appearance on imaging as other entities but has stippled calcifications within the lesion. The differential diagnosis often includes benign and malignant tumors such as fibrous dysplasia, chondroblastoma, enchondroma, and chondrosarcoma. Histology is required for diagnosis and treatment is typically surgical due to the potential for pain, pathologic fracture, and deformity. We report the clinical presentation, imaging findings, and management of two pediatric patients with fibrocartilaginous dysplasia of the proximal femur to (1) highlight that recognition that fibrous dysplasia may contain cartilage upon frozen section will avoid overly aggressive therapy, and (2) FCD can occur in the McCune-Albright syndrome.

Tibia vara caused by focal fibrocartilaginous dysplasia: A rare case report.

Focal fibrocartilaginous dysplasia is an uncommon benign bone condition that predominantly affects children and typically leads to varus deformities in the proximal tibia. It was first described by Bell in 1985. The etiology remains unknown and the diagnosis is radiological; biopsy is not necessary. We present a case of a 2-year-old child who presented to our department for a right limb varus deformity caused by focal fibrocartilaginous dysplasia.

Case report: Distraction osteogenesis of focal fibrocartilaginous dysplasia and literature review.

INTRODUCTION AND IMPORTANCE: Focal fibrocartilaginous dysplasia (FFCD) is a rare disease of the ulna that requires early surgical intervention. CASE PRESENTATION: We present a juvenile case and the outcomes of a corrected deformity. The fibrotic band that adhered to the ulna was resected, the ulna was osteotomized, and then an external fixator was placed for lengthening. The ulna's distal physis line was extended by 18 mm so that it would be the same length as the distal physis line of the radius. Full functional recovery occurred within three months. CLINICAL DISCUSSION: There have been 22 cases of ulnar FFCD reported in the literature. Our patient is the oldest reported thus far who developed radial head subluxation, but no dislocation occurred. CONCLUSION: FFCD is a broad-spectrum disease. Although its course is generally poor for patients with a late diagnosis, it is possible to obtain good results with correction procedures.

Acute Presentation and Long-Term Rehabilitation Follow-Up of Ischemic Myelopathy Due to Clinically Suspected Fibrocartilaginous Embolism in an Adolescent Male: A Case Report and Review.

Ischemic myelopathy is uncommon in the pediatric population, with fibrocartilaginous embolism (FCE) being one of its rarest causes. We present the case of an otherwise healthy 17-year-old student who experienced sudden onset of severe low-back pain amidst intensive physical training, which rapidly deteriorated to complete sensory-motor paralysis of his lower limbs. He was treated with IV Methylprednisolone and anticoagulation after the initial work-up suggested spinal cord infarction. After eight days, sufficient clinical-radiological correlation was achieved to support FCE diagnosis as the most likely cause of infarction. He subsequently received inpatient rehabilitation treatment for four months, after which he was followed as an outpatient for a total period of 16 months. While significant neurological and functional gains were achieved during this period, he also experienced some worsening. This case highlights the importance both of performing a thorough assessment and being familiar with FCE as a possible differential diagnosis of spinal cord infarction in children, to facilitate its timely identification and proper acute and long-term management. This case report was prepared following CARE guidelines after obtaining the patient's written informed consent.

An ischemic myelopathy case series: Flaccid paraplegia following a spike ball save and numbness while walking normally.

Spinal cord infarctions in children are rare and early magnetic resonance imaging studies are often negative. A high clinical suspicion must be maintained to identify stroke and initiate workup for underlying etiology to suggest appropriate treatment. We present two cases of spinal cord infarction without major preceding trauma. The first was caused by disc herniation and external impingement of a radiculomedullary artery and the second was due to fibrocartilaginous embolism with classic imaging findings of ventral and dorsal cord infarctions, respectively. These cases were treated conservatively with diagnostic workup and aspirin, though additional treatments which can be considered with prompt diagnosis are also explored in our discussion. Both cases recovered the ability to ambulate independently within months. Case 1 is attending college and ambulates campus with a single-point cane. Case 2 ambulates independently, though has some difficulty with proprioception of the feet so uses wheelchairs for long-distance ambulation.

Spinal Cord Infarct Due to Fibrocartilaginous Embolism in an Adolescent Boy: A Case Report and Literature Review.

Fibrocartilaginous embolism (FCE) is one of the rare causes of acute spinal cord infarction. We report the case of a previously healthy 14-year-old boy with this condition. A few hours after lifting heavy objects, he developed sudden quadriparesis. On examination, he had asymmetric hypotonic quadriparesis and normal dorsal column function but absent spinothalamic function in all limbs with sensory level to shoulder. Magnetic resonance imaging (MRI) of the spine confirmed the diagnosis of spinal infarction secondary to FCE. The patient initially received methylprednisolone and plasma exchange. A follow-up visit after neurorehabilitation showed improvement but with residual neurological deficit. Although FCE is rare, it should be kept as one of the differential diagnoses of an acute neurological deficit of the spinal cord.

Fibrocartilaginous dysplasia: What do we know so far?

Fibrocartilaginous dysplasia has been described as a rare variant of fibrous dysplasia. This lesion will appear in imaging as ground glass matrix similar to fibrous dysplasia, but it will also show rings and arcs calcifications. In turn, this can lead to misdiagnosing fibrocartilaginous dysplasia as primary cartilaginous lesion such as enchondroma or chondrosarcoma, neccesating histopathological confirmation. We report a case of fibrocartilaginous dysplasia in a 19 years old male with polyostotic fibrous dysplasia with prior pathologic fracture of the left femur. The patient presented with progressive swelling of the left thigh, imaging was done and showed enlargement of the fibrous dysplasia in the left femur with new rings and arcs matrix mineralization. The lesion was biopsied and microscopic evaluation revealed mainly cartilage islands with fibro-osseous tissue. We also discuss the possible origin of the cartilaginous component in this lesion, and its clinical course.

Tendon Cells Root Into (Instead of Attach to) Humeral Bone Head via Fibrocartilage-Enthesis.

Large joints are composed of two closely linked cartilages: articular cartilage (AC; rich in type II collagen, a well-studied tissue) and fibrocartilaginous enthesis (FE; rich in type I collagen, common disorder sites of enthesopathy and sporting injuries, although receiving little attention). For many years, both cartilages were thought to be formed by chondrocytes, whereas tendon, which attaches to the humeral bone head, is primarily considered as a completely different connective tissue. In this study, we raised an unconventional hypothesis: tendon cells directly form FE via cell transdifferentiation. To test this hypothesis, we first qualitatively and quantitatively demonstrated distinct differences between AC and FE in cell morphology and cell distribution, mineralization status, extracellular matrix (ECM) contents, and critical ECM protein expression profiles using comprehensive approaches. Next, we traced the cell fate of tendon cells using ScxLin (a tendon specific Cre ScxCreERT2; R26R-tdTomato line) with one-time tamoxifen induction at early (P3) or young adult (P28) stages and harvested mice at different development ages, respectively. Our early tracing data revealed different growth events in tendon and FE: an initial increase but gradual decrease in the ScxLin tendon cells and a continuous expansion in the ScxLin FE cells. The young adult tracing data demonstrated continuous recruitment of ScxLin cells into FE expansion during P28 and P56. A separate tracing line, 3.2 Col 1Lin (a so-called "bone-specific" line), further confirmed the direct contribution of tendon cells for FE cell formation, which occurred in days but FE ECM maturation (including high levels of SOST, a potent Wnt signaling inhibitor) took weeks. Finally, loss of function data using diphtheria toxin fragment A (DTA) in ScxLin cells demonstrated a significant reduction of ScxLin cells in both tendons and FE cells, whereas the gain of function study (by stabilizing ß-catenin in ScxLin tendon cells via one-time injection of tamoxifen at P3 and harvesting at P60) displayed great expansion of both ScxLin tendon and FE mass. Together, our studies demonstrated that fibrocartilage is an invaded enthesis likely originating from the tendon via a quick cell transdifferentiation mechanism with a lengthy ECM maturation process. The postnatally formed fibrocartilage roots into existing cartilage and firmly connects tendon and bone instead of acting as a simple attachment site as widely believed. We believe that this study will stimulate more intense exploring in this understudied area, especially for patients with enthesopathy and sporting injuries.

Horner syndrome as a physiological biomarker of disease in canine cervical myelopathy.

BACKGROUND: Horner syndrome often occurs with cervical myelopathies and might provide insight into the underlying disease and prognosis. OBJECTIVES: To describe the clinical and imaging features of dogs with cervical myelopathy and concurrent Horner syndrome and to determine association of Horner syndrome with diseases or magnetic resonance images (MRI). ANIMALS: Ninety-three client-owned dogs with cervical myelopathy and concurrent Horner syndrome and 99 randomly selected client-owned dogs with cervical myelopathy without Horner syndrome (control cases). METHODS: Retrospective study. Medical records were reviewed to identify Horner and control cases and clinical findings recorded. MRI were reviewed, and lesions characterized and recorded. Descriptive and comparative statistics were performed. RESULTS: Non-compressive disease occurred more frequently in the Horner group compared with controls (58%; 95% CI: 48-68 vs 9%; 95% CI: 5-16; P < .0001). The most common diseases were fibrocartilaginous embolism in the Horner group (44/93; 47%) and intervertebral disc extrusion (76/99; 77%) amongst controls. On MRI, parenchymal hyperintensity was seen more commonly in the Horner group (95%; 95% CI: 88-98) compared with controls (51%; 95% CI: 41-60; P < .0001). In the Horner group, dogs that did not survive to discharge (N = 13) had more extensive MRI lesions relative to the adjacent vertebral length (200%; IQR 110%-575%) compared with survivors (N = 80; 110%; IQR 40%-250%; P = .02). Lateralization of Horner signs and MRI changes matched in 54% of cases. The overall survival rate was high in both Horner (80/93; 86%) and control (95/99; 96%) groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Horner syndrome in cervical myelopathy is commonly associated with noncompressive intraparenchymal disease.

Cryopreserved allogeneic bone marrow mesenchymal stem cells show better osteochondral defect repair potential than adipose tissue mesenchymal stem cells.

Mesenchymal stem cells (MSCs) due to their characteristic properties have a potential to treat osteoarthritis, one of the major growing joint problems. MSCs show differential ex vivo chondrogenic potential on the basis of source that remains to be validated under in vivo environment. This study compared chondrogenic potential of MSCs derived from two common sources, adipose tissue (AD) and bone marrow (BM) under ex vivo and in vivo environments. The randomized placebo controlled osteochondral defect (OCD) study divided n = 72 rabbits equally into Control, AD-MSCs and BM-MSCs groups. Ex vivo chondrogenic induction resulted in an increased aggrecan fold expression in BM-MSCs and AD-MSCs. The former cell type had significantly (p<0.05) higher fold expression as compared to the latter. The cell treated OCDs had significantly reduced gene expression for inflammatory markers (IL-6, IL-8 and TNF-α) as compared to the control. In OCD study, radiography, MRI, gross observation, histopathology and SEM revealed that the cell treated defects were early filled by the tissue that had better surface architecture and matrices as compared to the control. BM-MSCs treated defects had better scores especially for gross and histopathology than the AD-MSCs. Gene expression for osteochondral regulation and cartilaginous matrices was higher in BM-MSCs group while only for matrices including the Col I in AD-MSCs as compared to the control. It was concluded that OCD in the cell treated groups are filled early with mostly a fibrocartilaginous to hyaline tissue. BM-MSCs may have an edge over AD-MSCs in OCD repair.

Fibrocartilaginous embolism: a rare cause leading to spinal cord infarction?

PURPOSE: Fibrocartilaginous nucleus pulposus components herniation and embolism rarely causes acute ischaemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome. The purpose of this study was to evaluate the topography and pattern of this rare myelopathy by MRI. METHODS: A retrospective observational case series of patients, admitted to our Institute between 2008 and 2021, with a diagnosis of fibrocartilaginous embolism based on typical clinical and radiological features. RESULTS: Five patients were identified (2 men and 3 women; range 13-38 years). No one had pre-existing vascular risk factors. All referred potential precipitating event in the 24 h prior to symptom onset. MRI findings showed increased signal intensity of the spinal cord on T2-weighted images in all cases and degenerative disc changes opposite to it in four of them. The outcome was poor: three showed only partial sensitivity and motor improvement (mRs 4, 3, and 2, respectively); one completely recovered except for isolated hand paresis (mRs 1); and one remained severely neurologically affected (mRs 5). CONCLUSIONS: Fibrocartilaginous embolism must be a differential diagnosis in case of otherwise unexplained spinal cord infarction in adult and paediatric low risk population. Neuroradiological findings such as abnormal spinal cord signal intensity and degenerative disc changes can aid in early diagnosis of this rare myelopathy. The prevalent myelopathy location was thoracic. All signal alterations were detected in the anterior region of the spinal cord in the territories of the anterior spinal artery.

Fibrocartilaginous mesenchymoma of pelvis-a potential diagnostic pitfall.

Fibrocartilaginous mesenchymoma (FM) is a rare bone tumor mimicking other fibrocartilaginous lesions on imaging and histologically. Hence, it is difficult to diagnose this entity especially on small biopsies. In this article, we report a case of FM mimicking desmoplastic fibroma on biopsy. A 36-year-old male presented with pain in the left hip. Imaging showed a large expansile lytic lesion involving the acetabulum and pubis. The differential diagnosis was suggestive of giant cell tumor, aneurysmal bone cyst, intraosseous desmoplastic fibroma, and chondrosarcoma. Biopsy revealed a low-grade spindle cell lesion with no evidence of osteoid or chondroid matrix. The lack of cartilaginous nodules in the biopsy prompted a preoperative diagnosis of desmoplastic fibroma. The excised mass showed bland spindle cell proliferation, benign cartilage nodules, and epiphyseal plate-like enchondral ossification suggestive of fibrocartilaginous mesenchymoma. Negative immunostaining for SATB2, CDK4, and MDM2 ruled out low-grade central osteosarcoma. Though GNAS mutations were not performed in this case, rimming of the bony trabeculae at the periphery of the epiphyseal growth plate-like cartilaginous nodule ruled out fibrous dysplasia. The absence of cartilaginous component misleads the diagnosis preoperatively in small biopsies.

Fibrocartilaginous Dysplasia - A Report of Five Cases with Review of Literature.

Introduction: Fibrocartilaginous dysplasia (FCD) is a variant of fibrous dysplasia (FD) with extensive cartilaginous differentiation. This has been reported in both monostotic and polyostotic types of FD, the proximal femur being the most common site involved. Case Report: We report five cases of fibrocartilaginous dysplasia with varying degrees of cartilaginous differentiation. The age of the patients ranged from 7 to 30 years, and there was a female predominance (M:F ratio of 1:4). The proximal femur was the site of involvement in all the cases. Imaging showed well demarcated radiolucent lesions with stippled calcifications. Histologically, cartilaginous areas were noted juxtaposed to typical areas of fibrous dysplasia. Four of the patients were treated with curettage and one with a marginal resection. None of the five cases had recurrences at the past follow-up. Conclusion: FCD is a rare variant of fibrous dysplasia which needs to diagnosed and treated early, as there is a high risk of pathological fracture.

Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation.

Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient's quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.

Update on Fibrocartilaginous Disease Clinical Examination.

This article provides an update on fibrocartilaginous disease clinical examination. Lesser metatarsophalangeal joint instability is a challenging entity for the foot and ankle surgeon. A correct diagnosis is crucial to instill an appropriate treatment plan that will result in a successful outcome and a satisfied patient. Insertional Achilles tendon disorders are common among active and inactive patients. There is also a high predilection for Achilles tendon pathology among athletes. In this article demographics and patient history, causative factors, differential diagnosis, physical examination, clinical tests, and radiographic evaluation are discussed for plantar plate disorders and insertional Achilles disorders.

Case report: Isolated acute dorsal distal radioulnar joint (DRUJ) dislocation.

INTRODUCTION: Isolated acute distal radioulnar joint (DRUJ) dislocation is a rare injury that should be early recognized and treated promptly to avoid the limitation and disability associated with delayed diagnosis and management. CASE PRESENTATION: We present a patient with a traumatic dorsal isolated DRUJ dislocation who was successfully treated with a closed reduction and k-wire pinning along with cast immobilization. DISCUSSION: Previous reports of distal radioulnar joint dislocation have described the mechanics of this injury as well as a guidance to diagnosis and treatment. Closed reduction, stabilization of wrist joint, and early mobilization of elbow joint can help in preserving the joint function and a faster recovery. CONCLUSION: Closed reduction under general anesthesia, DRUJ stabilization by k-wire pinning, and above elbow casting can be successful in most cases. We recommend an early transition to below elbow cast to encourage early elbow range of motion and prevent joint stiffness.