AJNR Am J Neuroradiol. 2026 Aug 31:ajnr.A9613. doi: 10.3174/ajnr.A9613. Online ahead of print.
ABSTRACT
BACKGROUND: Fibrocartilaginous embolism (FCE) is a rare but serious cause of spinal cord infarction. Vertical disc herniation (e.g., Schmorl’s nodes) may enable FCE in the thoracolumbar spine but is unlikely in the pediatric cervical spine. We hypothesized that radial disc herniation (annular fissuring), rather than vertical herniation, may contribute to cervical spinal cord infarction in children via an FCE mechanism.
METHODS: In this retrospective case-control study, the frequency of annular fissures and nuclear degeneration was assessed in patients with possible FCE from January 2004 to December 2023. The presumed diagnosis of FCE was based on clinical evaluation characteristic imaging findings of cord infarction, and exclusion of other diagnoses in electronic medical records. The two control groups included children without myelopathy (Control 1), selected during a 6-month consecutive sampling period from March to July 2014, and children with non-compressive cervical myelopathy (Control 2), selected through consecutive sampling from April 2004 to February 2014. Data analysis was performed using SPSS (IBM, version 29.0). The significance level was p<0.05.
RESULTS: A total of 156 children were included, 18 with possible FCE (Case) and 138 without (Control 1 and Control 2 with 39 and 99 patients, respectively). The median ages (IQR) were 12.6 (9.0-16.5), 9.6 (5.0-15.6), and 10.3 (5.0-14.6) years for Case, Control 1, and Control 2 groups respectively and 48.1% (75/156) were female. Annular fissures were observed in 28.8% (45/156) across ≥1 disc levels, and all patients showed nuclear degeneration at one or more disc levels. Among FCE patients, 88.9% (16/18) had at least one annular fissure. The odds ratio of having an annular fissure in FCE patients compared with the total control group was 30.06 (CI [6.53-138.30]). The odds ratio compared with Control 1 was 31.60 (CI [6.70-148.83]) and compared with Control 2 was 26.66 (CI [5.13-138.56]).
CONCLUSION: This study demonstrated a statistically significant association between annular fissures and cervical spinal cord infarction. This finding is consistent with the theory that disc material may embolize through a radial annular tear into the cervical spinal cord microcirculation.
PMID:42674965 | DOI:10.3174/ajnr.A9613
