Hérnias discais no cão: estudo de 18 casos e importância dos meios de diagnóstico imagiológicos
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2016-02-25
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A compressão da medula espinhal, secundária a uma extrusão ou protrusão do disco intervertebral é uma das causas mais comuns de défices neurológicos em animais de companhia. As hérnias discais dividem-se em duas categorias distintas: Hansen tipo I, que resultam da herniação do núcleo pulposo através do anel fibroso e extrusão para o canal vertebral e Hansen tipo II que resultam duma protrusão do anel fibroso. As manifestações clínicas da doença do disco intervertebral podem variar desde a hiperestesia paraespinhal até à tetraplegia e em casos muito graves pode haver perda de sensibilidade à dor profunda. As hérnias discais são mais comuns a nível cervical (C2-C3) e na transição toracolombar (T11-L3). Neste estudo observaram-se 18 cães, cujo diagnóstico foi feito pela anamnese e exame neurológico seguidos de RX, mielografia e RM efetuados à área de lesão suspeita. Como a RM não utiliza radiação ionizante tem vindo a ser cada vez mais utilizada em Medicina Veterinária. Neste estudo 15 (83,3%) dos animais realizaram RX 12 (66,6%) realizaram mielografia e 16 (88,8%) fizeram RM. Apenas dois animais não fizeram RM devido a recusa dos proprietários. Todas as suspeitas diagnósticas de extrusão/protrusão indicadas pelo RX e mielografia foram confirmadas pela RM. A hérnia discal Hansen tipo I (50%) foi mais comum que a hérnia discal Hansen tipo II (11,1%) assim como as hérnias discais toracolombares foram mais frequentes (72,2%) que as hérnias discais cervicais (27,8%). O segmento cervical mais afetado foi C4-C5 (22,2%) e o lombar foi L2-L4 (16,7%). Nos nossos dados a compressão ventral foi a mais frequente (33,3%). Na faixa etária os dados obtidos vão de encontro ao referido na revisão bibliográfica pois o aparecimento de hérnias nas raças condrodistróficas, acontece mais entre os 3 e os 9 anos de idade e nas raças não condrodistróficas entre os 3 e 14 anos. Nos dados que obtivemos da distribuição por raças houve maior incidência nas raças não condrodistróficas (72,2%) do que nas raças condrodistróficas (27,8%). Este estudo permitiu concluir que com a realização dos exames imagiológicos adequados foi possível a deteção e confirmação precoce da localização da hérnia discal para decisão e planeamento posterior do tratamento a ser efetuado.
The spinal cord compression, secondary to an extrusion or protrusion of the intervertebral disc is one of the most common causes of neurological deficits in pet animals. The intervertebral disc hernias are divided in two distinct categories: Hansen type I, resulting from herniated nucleus pulposus through the fibrous ring and extrusion to the vertebral canal and Hansen type II, resulting from a protrusion of the fibrous ring. The clinical manifestations of intervertebral disc disease may vary from paraspinal hyperesthesia to tetraplegia and loss of sensitivity to deep pain can occur in many severe cases. Degenerative changes can occur in any intervertebral disc, being more common in C2-C3 and in thoracolumbar transition T11-L3. In this study we observed 18 dogs and the diagnosis was confirmed by clinical history and neurological examination followed by x-ray, myelography and MR made to the area of suspected injury. As MR does not use ionizing radiation has been increasingly used in veterinary medicine. In our sample, 83,3% of the animals did x-ray, 66,6% myelography and 88,8% MR. The only two cases witch did not performed MR were due to refusal of the owners. All diagnostic suspicions off extrusion/protrusion indicated by the x-ray and myelography were confirmed by RM. Hansen type I hernia was present is 50% dogs and Hansen type II in 11,1%. The thoracolumbar hernias were more common than cervical type ones, being present in 72,2% of the cases and 27,8% respectively. The most affected segment was cervical C4-C5 (22,2%) and was the lumbar L2-L4 (16,7%). In this study the ventral compression was the most common (33,3%). Like some literature, demonstrated that the appearance of hernias in chondrodystrophic breeds happens more between 3 and 9 years of age and in non-chondrodystrophic breeds between 3 and 14 years. However, the incidence of hernias in non-chondrodystrophic breeds was 72,2% and in chondrodystrophic was 27,8%, which was not verified in other studies. This study concluded that with a realization of diagnostic imaging was possible early detection and confirmation of the location of the disc herniation for decision and subsequent treatment planning to be done.
The spinal cord compression, secondary to an extrusion or protrusion of the intervertebral disc is one of the most common causes of neurological deficits in pet animals. The intervertebral disc hernias are divided in two distinct categories: Hansen type I, resulting from herniated nucleus pulposus through the fibrous ring and extrusion to the vertebral canal and Hansen type II, resulting from a protrusion of the fibrous ring. The clinical manifestations of intervertebral disc disease may vary from paraspinal hyperesthesia to tetraplegia and loss of sensitivity to deep pain can occur in many severe cases. Degenerative changes can occur in any intervertebral disc, being more common in C2-C3 and in thoracolumbar transition T11-L3. In this study we observed 18 dogs and the diagnosis was confirmed by clinical history and neurological examination followed by x-ray, myelography and MR made to the area of suspected injury. As MR does not use ionizing radiation has been increasingly used in veterinary medicine. In our sample, 83,3% of the animals did x-ray, 66,6% myelography and 88,8% MR. The only two cases witch did not performed MR were due to refusal of the owners. All diagnostic suspicions off extrusion/protrusion indicated by the x-ray and myelography were confirmed by RM. Hansen type I hernia was present is 50% dogs and Hansen type II in 11,1%. The thoracolumbar hernias were more common than cervical type ones, being present in 72,2% of the cases and 27,8% respectively. The most affected segment was cervical C4-C5 (22,2%) and was the lumbar L2-L4 (16,7%). In this study the ventral compression was the most common (33,3%). Like some literature, demonstrated that the appearance of hernias in chondrodystrophic breeds happens more between 3 and 9 years of age and in non-chondrodystrophic breeds between 3 and 14 years. However, the incidence of hernias in non-chondrodystrophic breeds was 72,2% and in chondrodystrophic was 27,8%, which was not verified in other studies. This study concluded that with a realization of diagnostic imaging was possible early detection and confirmation of the location of the disc herniation for decision and subsequent treatment planning to be done.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Cães , Deslocamento do disco intervertebral , Exame neurológico , Espectroscopia de ressonância magnética , Exames complementares de diagnóstico