Espondilomielopatia cervical: técnica cirúrgica de distração/estabilização vertebral com cunha de titânio, implante metálico e cimento ósseo
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2014
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A Espondilomielopatia Cervical, também denominada de Síndrome de Wobbler, é uma síndrome dinâmica, que afeta as vértebras cervicais caudais e os discos invertebrais de cães de raças de grande porte e gigantes. É uma doença bastante comum em raças como Doberman Pinscher e Grand Danois, apesar de também surgir noutras raças. Os machos são geralmente mais afetados.
A etiologia da Espondilomielopatia Cervical é multifatorial, porém, alguns fatores importantes contribuem para o desenvolvimento desta síndrome, como a estenose do canal vertebral, instabilidade vertebral, hérnia de disco, hipertrofia ligamentar, proliferação da cápsula articular e produção de osteófitos.
O quadro clínico está associado às deficiências neurológicas secundárias à lesão compressiva da medula espinhal (mielopatia) ou das raízes nervosas (radiculopatia), ou mesmo de ambas. O animal pode apresentar ataxia dos membros pélvicos, com ou sem dor cervical, que pode progredir para défices neurológicos dos membros anteriores e em última instância quadriplegia.
O diagnóstico de EMC é feito com base na sintomatologia clínica e recorrendo à realização de exames complementares (Mielografia, Tomografia Computorizada e/ou Ressonância Magnética).
O tratamento a ser instituído depende da complexidade das lesões envolvidas, grau de compressão da medula espinhal, condição geral do animal, disponibilidade de instrumentos e implantes cirúrgicos, bem como da capacidade técnica do cirurgião. Este, consiste na descompressão espinhal e na reversão dos défices neurológicos.
O prognóstico pode ser muito variável, pois depende do estado neurológico do animal, das causas predisponentes, da evolução e da extensão da lesão espinhal.
O presente trabalho tem como objetivo descrever dois casos clínicos de Espondilomielopatia Cervical no cão, enfatizando os aspetos clínicos e terapêuticos desta enfermidade e incidindo no tratamento cirúrgico à base de Distração/Estabilização com Implante Metálico, Cunha de Titânio e Cimento Acrílico Ósseo.
Neste trabalho, foram abordados animais com diferente sintomatologia e manifestação clínica, no entanto, com desfecho cirúrgico semelhante, sendo ambos tratados com a técnica de Distração/Estabilização com Implante Metálico, Cunha de Titânio e Cimento Acrílico Ósseo, apesar da variância dos casos clínicos, com um caso a ter apenas um espaço discal afetado e o outro apresentar lesão em mais que um espaço. Os animais foram acompanhados durante toda a sua estadia no Hospital Veterinário, desde a anamnese inicial, passando pelos métodos de diagnóstico até ao tratamento cirúrgico. Foi feito também um acompanhamento da evolução e recuperação destes mesmos animais, tanto no pós-cirúrgico precoce como no pós-cirúrgico tardio, com constantes visitas ao Hospital Veterinário, de modo a avaliar o animal, com preocupação direcionada à coluna vertebral cervical e exame neurológico completo de modo a avaliar as alterações neurológicas e comparação dos défices apresentados pelo animal, com especial atenção para a sintomatologia “típica” desta síndrome.
Os casos analisados refletem, embora de forma distinta, historial clínico e predisposição racial para a típica Espondilomielopatia Cervical, com a abordagem cirúrgica a ser baseada na mesma técnica de distração vertebral, técnica essa que é objeto deste mesmo estudo.
Cervical Spondylomyelopathy, also called Wobbler Syndrome, is a dynamic condition that affects the caudal cervical vertebrae and intervertebral discs of large and giant breed dogs. It is a fairly common disease in breeds like Doberman Pinscher and Great Dane, although also arise in other breeds. Males are more often affected. The etiology of Cervical Spondylomyelopathy is multifactorial, however, some important factors contribute to the development of this syndrome, such as spinal stenosis, spinal instability, disc herniation, ligamentous hypertrophy, proliferation of the articular capsule and production of osteophytes. The clinical signs are associated with neurological deficits secondary to spinal cord compression (myelopathy) or nerve roots (radiculopathy), or even both. The animal may exhibit ataxia of the pelvic limbs, with or without neck pain, which may progress to neurological deficits in the forelimbs and ultimately quadriplegia. The diagnosis of this disease is based on clinical symptoms and in the use of the complementary examinations (Myelography, CT and / or MRI). The treatment procedure depends on the complexity of the injuries involved, degree of spinal cord compression, the patient's overall condition, availability of surgical instruments and implants as well as the technical ability of the surgeon. This consists of spinal decompression and reversal of neurological deficits. The prognosis can be very variable because it depends on the neurological status of the animal, the predisposing causes of the disease, the evolution and extent of spinal injury. This study aims to describe two clinical cases of Cervical Spondylomyelopathy on dog, emphasizing clinical and therapeutic aspects of this disease and focusing on surgical treatment based on Vertebral Distraction/Stabilization with Titanium Wedge, Metal Implant and Acrylic Bone Cement method. In this study, different animals have been approached with different clinical signs and symptoms, however, with similar surgical outcome, both treated with the Distraction/Stabilization with Titanium Wedge, Metal Implant and Acrylic Bone Cement, although in one case just one disc space has been addressed and in the other one more than a disc space was approached. The animals were followed throughout their stay at the Veterinary Hospital, from initial history taking, through the methods of diagnosis to surgical treatment. Also by the motorization of the progress and recovery in these animals, both in the early postoperative period and in the late postoperative period, with constant visits to the Veterinary Hospital, in order to assess the animal with concern directed at the cervical spine and complete neurological examination so assessing the neurological deficits and comparison presented by the animal, with special attention to the "typical" symptoms of this syndrome. These instances reflect, although differently, clinical history and racial predisposition for typical Cervical Spondylomyelopathy with surgical approach based on the same technique of vertebral distraction, which is the subject of this study.
Cervical Spondylomyelopathy, also called Wobbler Syndrome, is a dynamic condition that affects the caudal cervical vertebrae and intervertebral discs of large and giant breed dogs. It is a fairly common disease in breeds like Doberman Pinscher and Great Dane, although also arise in other breeds. Males are more often affected. The etiology of Cervical Spondylomyelopathy is multifactorial, however, some important factors contribute to the development of this syndrome, such as spinal stenosis, spinal instability, disc herniation, ligamentous hypertrophy, proliferation of the articular capsule and production of osteophytes. The clinical signs are associated with neurological deficits secondary to spinal cord compression (myelopathy) or nerve roots (radiculopathy), or even both. The animal may exhibit ataxia of the pelvic limbs, with or without neck pain, which may progress to neurological deficits in the forelimbs and ultimately quadriplegia. The diagnosis of this disease is based on clinical symptoms and in the use of the complementary examinations (Myelography, CT and / or MRI). The treatment procedure depends on the complexity of the injuries involved, degree of spinal cord compression, the patient's overall condition, availability of surgical instruments and implants as well as the technical ability of the surgeon. This consists of spinal decompression and reversal of neurological deficits. The prognosis can be very variable because it depends on the neurological status of the animal, the predisposing causes of the disease, the evolution and extent of spinal injury. This study aims to describe two clinical cases of Cervical Spondylomyelopathy on dog, emphasizing clinical and therapeutic aspects of this disease and focusing on surgical treatment based on Vertebral Distraction/Stabilization with Titanium Wedge, Metal Implant and Acrylic Bone Cement method. In this study, different animals have been approached with different clinical signs and symptoms, however, with similar surgical outcome, both treated with the Distraction/Stabilization with Titanium Wedge, Metal Implant and Acrylic Bone Cement, although in one case just one disc space has been addressed and in the other one more than a disc space was approached. The animals were followed throughout their stay at the Veterinary Hospital, from initial history taking, through the methods of diagnosis to surgical treatment. Also by the motorization of the progress and recovery in these animals, both in the early postoperative period and in the late postoperative period, with constant visits to the Veterinary Hospital, in order to assess the animal with concern directed at the cervical spine and complete neurological examination so assessing the neurological deficits and comparison presented by the animal, with special attention to the "typical" symptoms of this syndrome. These instances reflect, although differently, clinical history and racial predisposition for typical Cervical Spondylomyelopathy with surgical approach based on the same technique of vertebral distraction, which is the subject of this study.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Vertebras cervicais , Compressão da medula espinal , Diagnóstico , Descompressão cirúrgica , Terapêutica , Síndrome de Wobbler , Técnica Distração/Descompressão , Défices neurológicos , Titânio