ABSTRACT: Fibrocartilagenous embolic myelopathy (FCEM) is a neurological condition mostly seen in large dogs, but that can affect all breeds. Predisposed breeds include Labrador retrievers and miniature Schnauzers.

The onset of clinical signs often occurs following exercise or some form of mild trauma, such as jumping to catch a frisbee. It is generally considered to be a non-painful condition, although owners often report apparent pain or vocalisation when signs first occur.

FCEM occurs when fibrocartilaginous material from the intervertebral disc – called the ‘nucleus pulposus’ – enters the arterial system and is carried to the spinal cord where it causes a blood vessel obstruction. This ‘embolism’ starves the spinal cord of essential oxygenation and nutrients and its severity will determine the loss of function seen in the patient.

FCEM can affect front or hind limbs – or both. It can be unilateral or bilateral, but often only one side of the body will be seen to be affected. The signs can vary from lameness to complete loss of function (paralysis).


A diagnosis is reached by means of an accurate history, a careful neurological examination and further imaging such as magnetic resonance imaging (MRI).

This presentation is somewhat different to that of a disc herniation where an intervertebral disc is pushing on the spinal cord (Figures 1 & 2). This is often a very painful condition and will appear different on further imaging, such as MRI scanning.

Figure 1: The highlighted region of the FCEM lesion

Figure 2: Disc extrusions

Treatment options

FCEM will often ‘self-cure’ over weeks or months, especially if it does not involve the lower motor neuron nerve supply to the limbs. If there is no improvement seen within 14 days then euthanasia is advised. The condition, therefore, requires conservative management, nursing care and rehabilitation.

Nursing requirements

As in all conditions, the patient’s needs must be considered and an appropriate nursing care plan devised with the supervising veterinarian. This should include the following points:


Orthopaedic mattresses should be used for patients who are not mobile. Turn the patient every two to four hours to aid circulation, prevent hypostatic pneumonia and decubitus ulcers and use a ‘VetBed’ to ensure the patient is dry, even if soiling occurs.

Bladder management

If loss of function is such that the patient is unable to urinate voluntarily, this needs to be managed by either catheterisation or manual expression (at least three times a day).


If the patient is overweight, a suitable diet plan is needed. This will aid recovery and mobility. A reduced calorie diet is advised for immobile patients.


A stress-free environment is essential, especially for a patient that is immobile. Time, grooming and stimulation are equally as important for a patient’s recovery.


This is perhaps the most important factor in FCEM patient management, with the goal being to return the patient back to normal function (Table 1).


The affected limbs should be massaged from the toes, working up the limb in small circular motions. This will aid circulation, prevent muscle tension and make the patient more comfortable.

It is often the first point of contact to the animal which will help relax the patient before using other techniques.


The goals of bicycling are gait patterning, training and preservation, or improving joint range of motion (Figures 3, 4 & 5). The patient’s foot is grasped and gently moved in a flowing, circular, caudal to dorsal and cranial motion.

Figures 3, 4, 5: The patient's foot is grasped and gently moved in a flowing, circular, caudal to dorsal and cranial motion.

Assisted exercises

It is important to stand the patient up.

If the dog is large, then support may be required. This can be in the form of a ‘physio roll’, sling or hoist.

Active exercises

Once the patient is fairly active and able to walk – either assisted or unassisted – slow lead walks will aid muscle strength. These should be so slow that the patient uses all limbs. For instance, a small dog that is lame on one limb will tend to try and rush when walking and only use three limbs, holding the affected one up.


Hill walking or steps will aid in strengthening. In Figure 6 it can be seen that the weight is pushed backwards, so that the hind legs are working harder.

Figure 6: HiLL walking or steps will aid in strengthening


Position yourself behind the patient and encourage it to sit squarely and push off equally on both legs (another useful strengthening exercise) (Figures 7, 8 & 9).

Figures 7,  8, 9: Sit-to-stands

Neuro-muscular electro-stimulation (NMES)

This is more of a specialised tool for trained physiotherapists, rehabilitation practitioners and nurses. It is used to stimulate muscles that have little or no activity in them. Pads are placed at the muscle inserts and electro-pulses are sent through the muscle to stimulate a contraction. The settings and length of time will vary from patient to patient.


An underwater treadmill or a swimming pool are fantastic ways of building up muscle and improving usage. Most dogs enjoy swimming and w
ill use their limbs more effectively when in water.



Nicola Rose is a qualified veterinary nurse and Certified Canine Rehabilitation practitioner She works at the Veterinary Practice in Braintree. Her main interests are within neurology and orthopaedics, in which disciplines rehabilitation is highly valued.

Suggested reading

BOCKSTAHLER, B., LEVINE, D., MILLIS, D. (2004) Essential Facts of Physiotherapy in Dogs & Cats – Rehabilitation and Pain Management De LAHUNTA, A., GLASS, E. N. (2008) Veterinary Neuroanatomy and Clinical Neurology, Saunders




• VOL 25 • No12 • December 2010 • Veterinary Nursing Journal