Doença do disco intervertebral na região toracolombar em cães: revisão de 16 casos clínicos
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2020-09-17
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A doença do disco intervertebral na região toracolombar é a mielopatia mais frequentemente encontrada na prática de medicina veterinária. Esta manifesta-se, sobretudo, quando o disco intervertebral sofre um processo de degenerescência por metaplasia condroide ou metaplasia fibroide. Este processo de degenerescência resulta na saída de material do interior do disco intervertebral para o canal vertebral, que se pode classificar como uma extrusão ou uma protusão, consoante a fisiopatologia envolvida. Existem, atualmente, vários meios de diagnóstico que visam localizar, classificar e quantificar o material discal herniado. Tanto o exame neurológico como os sinais clínicos presentes em cada caso são indispensáveis para caracterizar o estado do animal e deduzir uma localização da lesão. Porém, o diagnóstico por imagem é aquele que oferece uma maior garantia e precisão na caracterização desta doença. Aqui, incluem-se o recurso a imagens por mielografia, tomografia computorizada e ressonância magnética. Após a caracterização e localização do material herniado é, então, possível proceder-se ao seu tratamento. Enquanto que o tratamento conservativo pode ser a solução em alguns casos, em muitos outros o tratamento cirúrgico é o mais recomendado. Várias técnicas cirúrgicas estão descritas (entre elas a hemilaminectomia), tendo cada uma as suas indicações. A recuperação e reabilitação física é extremamente relevante e, como tal, deve ser acompanhada ao detalhe. Este trabalho teve como objetivo realizar um estudo retrospetivo sobre a doença do disco intervertebral na região toracolombar em cães. Para este efeito, durante um período de estágio no Hospital Veterinari Molins, foram acompanhados dezasseis casos clínicos de cães que apresentavam como diagnóstico definitivo uma doença do disco intervertebral na região toracolombar. Dos dezasseis, nove eram cães de raça condrodistrófica. Com este estudo, confirmou-se que a raça condrodistrófica é mais predisposta a uma extrusão do disco, enquanto que as restantes são mais predispostas à protusão. Também se constatou que o tratamento cirúrgico é essencial em animais que exibam um grau III de gravidade de sintomatologia. Nos animais submetidos a cirurgia, a taxa de sucesso da técnica cirúrgica aplicada foi de 92,9%, com recuperação da locomoção num período que variou entre os três e os vinte e sete dias. O único caso em que não houve recuperação de atividade locomotora (7,1%), representa um animal que se encontrava em grau V de gravidade de sinais clínicos, o que suporta a teoria de que o aumento do grau de disfunção neurológica remete para um prognóstico pior.
Intervertebral disc disease in the thoracolumbar region is the most frequently found myelopathy in veterinary medicine. This occurs, mainly, when the intervertebral disc undergoes a degeneration process due to either chondroid metaplasia or fibroid metaplasia. This degeneration process results in the parting of disc material from the interior of the intervertebral disc into the vertebral canal, which can be classified as extrusion or protrusion, depending on the pathophysiology involved. Currently, there are several diagnostic methods that aim to locate, classify and quantify the herniated disc material. Both neurological examination and the clinical signs present in each case are essential to characterize the state of the animal and infer the location of the lesion. However, the diagnostic imaging is the one that offers us a greater guarantee and precision in the characterization of this disease. This includes the use of myelography, computed tomography and magnetic resonance imaging. After characterizing and locating the herniated material, it is possible to proceed with its treatment. While conservative treatment may be the solution in some cases, in many others it is the surgical treatment the most recommended. Various surgical techniques are described (such as the hemilaminectomy) and each one has its own indications. Recovery and physical rehabilitation are also extremely important and, as such, must be followed in detail. This work aimed to carry out a retrospective study on intervertebral disc disease in the thoracolumbar region in dogs. To that end, during an internship at Hospital Veterinari Molins, were followed sixteen clinical cases of dogs with herniated discs in the thoracolumbar region as a definitive diagnosis. Of the sixteen, nine were dogs of chondrodystrophic breed. With this study, it was perceived that a chondrodystrophic breed is more predisposed to a disk extrusion while the nonchondrodystrophic are more predisposed to protrusion. It was also noticed that surgical treatment is essential in animals that exhibit a grade III severity of clinical signs. Of the animals that underwent surgery, the success rate of the surgical technique applied was 92.9% and they recovered ambulation in a period that varied between three and twenty-seven days. The only case in which there was no recovery of the locomotor activity (7.1%), represents an animal that was classified as a degree V of gravity of clinical signs, which supports the theory that an increase in the degree of neurological disfunction suggests a worse prognosis.
Intervertebral disc disease in the thoracolumbar region is the most frequently found myelopathy in veterinary medicine. This occurs, mainly, when the intervertebral disc undergoes a degeneration process due to either chondroid metaplasia or fibroid metaplasia. This degeneration process results in the parting of disc material from the interior of the intervertebral disc into the vertebral canal, which can be classified as extrusion or protrusion, depending on the pathophysiology involved. Currently, there are several diagnostic methods that aim to locate, classify and quantify the herniated disc material. Both neurological examination and the clinical signs present in each case are essential to characterize the state of the animal and infer the location of the lesion. However, the diagnostic imaging is the one that offers us a greater guarantee and precision in the characterization of this disease. This includes the use of myelography, computed tomography and magnetic resonance imaging. After characterizing and locating the herniated material, it is possible to proceed with its treatment. While conservative treatment may be the solution in some cases, in many others it is the surgical treatment the most recommended. Various surgical techniques are described (such as the hemilaminectomy) and each one has its own indications. Recovery and physical rehabilitation are also extremely important and, as such, must be followed in detail. This work aimed to carry out a retrospective study on intervertebral disc disease in the thoracolumbar region in dogs. To that end, during an internship at Hospital Veterinari Molins, were followed sixteen clinical cases of dogs with herniated discs in the thoracolumbar region as a definitive diagnosis. Of the sixteen, nine were dogs of chondrodystrophic breed. With this study, it was perceived that a chondrodystrophic breed is more predisposed to a disk extrusion while the nonchondrodystrophic are more predisposed to protrusion. It was also noticed that surgical treatment is essential in animals that exhibit a grade III severity of clinical signs. Of the animals that underwent surgery, the success rate of the surgical technique applied was 92.9% and they recovered ambulation in a period that varied between three and twenty-seven days. The only case in which there was no recovery of the locomotor activity (7.1%), represents an animal that was classified as a degree V of gravity of clinical signs, which supports the theory that an increase in the degree of neurological disfunction suggests a worse prognosis.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Doença disco intervertebral , toracolombar