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Hérnia discal intervertebral tipo II toracolombar em cães : diagnóstico e tratamento cirúrgico de sete casos clínicos
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Resumo(s)
As hérnias discais intervertebrais tipo II toracolombares, tipicamente associadas ao processo de degenerescência fibrosa que afeta os discos intervertebrais, consistem na protrusão do núcleo pulposo associada a um enfraquecimento e rutura parcial das fibras do anel fibroso.
O resultado é a extensão focal de ambas as estruturas para o canal vertebral, com compressão crónica e progressiva da medula espinhal e ligamento longitudinal dorsal.
A doença é sobretudo reconhecida em animais mais velhos, de raças não condrodistróficas de grande porte, podendo no entanto afetar raças condrodistróficas.
Os animais apresentam-se geralmente com uma história clínica crónica e progressiva e sinais clínicos ligeiros como ataxia dos membros pélvicos e paraparésia ambulatória.
O diagnóstico é baseado nos dados do animal, história pregressa, resultados do exame neurológico, radiografias simples e o diagnóstico definitivo requer imagiologia avançada como mielografia, tomografia computorizada (TC) ou ressonância magnética (RM). A RM é considerado o exame imagiológico de eleição para o diagnóstico da doença e caracterização das lesões associadas.
O tratamento pode ser conservador, com recurso a anti-inflamatórios, repouso e fisioterapia, ou cirúrgico. O tratamento cirúrgico poderá incluir técnicas descompressivas como hemilaminectomia, minihemilaminectomia, corpectomia lateral ou técnicas de estabilização vertebral. O prognóstico é mais reservado, independentemente do tratamento instituído e, a longo prazo muitas vezes não se revela satisfatório
O objetivo da componente prática deste trabalho é contribuir com informação referente à abordagem de cães afetados por hérnia discal intervertebral tipo II, através da exposição de sete casos clínicos com diagnóstico da doença tratados cirurgicamente, assim como revisar a literatura mais recente sobre o tema em questão.
A análise permitiu na generalidade confirmar a informação recolhida, tendo-se verificado que a doença surge na maioria dos casos em cães de raça não condrodistróficas e em idade mais avançada. Os discos intervertebrais T12-T13, T13-L1 e L1-L2 surgem com frequência afetados. A RM revela-se bastante útil na avaliação e caracterização das lesões. A presença de múltiplas protrusões e espondilose deformante ventral é comum nestes pacientes. A abordagem clínica e cirúrgica dos animais afetados é bastante variável e a sua recuperação é muitas vezes incompleta, podendo permaner défices neurológicos residuais.
ABSTRACT - THORACOLOMBAR INTERVERTEBRAL DISC PROTRUSION IN DOGS: DIAGNOSIS AND SURGICAL TREATMENT IN SEVEN CLINICAL CASES - The thoracolumbar type II intervertebral disc herniation, typically associated with the fibrous metaplasia that affect the intervertebral discs, consist in the protrusion of the nucleus pulposus, associated with the weakening and partial rupture of the annulus fibrosus. The result is the focal extension of both structures to the vertebral canal, with progressive and chronic compression of the spinal cord and the dorsal longitudinal ligament. This disease is mostly found in older animals of nonchondrodistrophic large breeds, although it can also affect chondrodistrophic ones. The animals usually present a progressive and chronic clinical history and mild clinical signs such as ataxia of the hindlimbs and ambulatory paraparesis. The diagnosis is based on the animal’s signalment, clinical history, results of the neurological exam, radiographic findings, and the final diagnosis requires advanced imaging tests such as mielography, computed tomography (CT) or magnetic resonance imaging (MRI). The MRI is considered the imaging test of choice for the diagnosis of the disease and characterization of the associated lesions. The treatment can be conservative, resorting to anti-inflammatory drugs, rest and physiotherapy, or surgical. The surgical treatment may include decompressive technics such as hemilaminectomy, minihemilaminectomy, lateral corpectomy and vertebral stabilization techniques. The prognosis is more reserved, regardless of the chosen treatment and, in the long term, is often not satisfactory. The goal of the practical component of this dissertation is to contribute with information concerning the approach to dogs affected by intervertebral type II disc herniation, through the presentation of seven clinical cases diagnosed with this disease and that had surgical treatment, as well as to review the most recent literature on the subject. In general, the analysis made it possible to confirm the information consulted, and we were able to verify that the disease occurs in most cases in nonchondrodistrophic breeds and in dogs of older age. The intervertebral discs T12-T13, T13-L1 and L1-L2 frequently appear affected. MRI proved to be quite useful in the evaluation and characterization of the lesions. The presence of multiple protrusions and spondylosis deformans ventral is common in these patients. The clinical and surgical approach to the affected animals is quite variable and the recovery is often incomplete, and residual neurological deficits may remain.
ABSTRACT - THORACOLOMBAR INTERVERTEBRAL DISC PROTRUSION IN DOGS: DIAGNOSIS AND SURGICAL TREATMENT IN SEVEN CLINICAL CASES - The thoracolumbar type II intervertebral disc herniation, typically associated with the fibrous metaplasia that affect the intervertebral discs, consist in the protrusion of the nucleus pulposus, associated with the weakening and partial rupture of the annulus fibrosus. The result is the focal extension of both structures to the vertebral canal, with progressive and chronic compression of the spinal cord and the dorsal longitudinal ligament. This disease is mostly found in older animals of nonchondrodistrophic large breeds, although it can also affect chondrodistrophic ones. The animals usually present a progressive and chronic clinical history and mild clinical signs such as ataxia of the hindlimbs and ambulatory paraparesis. The diagnosis is based on the animal’s signalment, clinical history, results of the neurological exam, radiographic findings, and the final diagnosis requires advanced imaging tests such as mielography, computed tomography (CT) or magnetic resonance imaging (MRI). The MRI is considered the imaging test of choice for the diagnosis of the disease and characterization of the associated lesions. The treatment can be conservative, resorting to anti-inflammatory drugs, rest and physiotherapy, or surgical. The surgical treatment may include decompressive technics such as hemilaminectomy, minihemilaminectomy, lateral corpectomy and vertebral stabilization techniques. The prognosis is more reserved, regardless of the chosen treatment and, in the long term, is often not satisfactory. The goal of the practical component of this dissertation is to contribute with information concerning the approach to dogs affected by intervertebral type II disc herniation, through the presentation of seven clinical cases diagnosed with this disease and that had surgical treatment, as well as to review the most recent literature on the subject. In general, the analysis made it possible to confirm the information consulted, and we were able to verify that the disease occurs in most cases in nonchondrodistrophic breeds and in dogs of older age. The intervertebral discs T12-T13, T13-L1 and L1-L2 frequently appear affected. MRI proved to be quite useful in the evaluation and characterization of the lesions. The presence of multiple protrusions and spondylosis deformans ventral is common in these patients. The clinical and surgical approach to the affected animals is quite variable and the recovery is often incomplete, and residual neurological deficits may remain.
Descrição
Dissertação de Mestrado integrado em Medicina Veterinária
Palavras-chave
hérnia discal intervertebral tipo II degenerescência fibrosa ressonância magnética type II intervertebral disc herniation fibrous degeneration magnetic resonance imaging
Contexto Educativo
Citação
Rodrigues, M.I.V. (2016). Hérnia discal intervertebral tipo II toracolombar em cães : diagnóstico e tratamento cirúrgico de sete casos clínicos. Dissertação de mestrado. Universidade de Lisbao, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade de Lisboa, Faculdade de Medicina Veterinária