Hérnia discal toracolombar no cão: Estudo da casuística cirúrgica do Hospital Veterinário da UTAD
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2018-11-06
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As hérnias do disco intervertebral desenvolvem-se com maior frequência na região toracolombar. As hérnias toracolombares ocorrem tanto em raças condrodistróficas como em raças não condrodistróficas, e podem ocorrer por extrusão (Hansen tipo I) ou protusão (Hansen tipo II). A lesão medular provocada pela herniação do disco intervertebral, a nível toracolombar, pode causar défices neurológicos, que variam desde hiperestesia local e ataxia, até tetraplegia e perda da nociceção. Para avaliar a gravidade da lesão da medula espinal, é necessária a realização do exame clínico, que permitirá correlacionar os sinais clínicos com os resultados do exame neurológico, e estabelecer um prognóstico. O diagnóstico é baseado essencialmente no exame neurológico e nos exames imagiológicos, como a mielografia, a tomografia computorizada ou a ressonância magnética. As opções de terapêutica são o tratamento conservativo (repouso e anti-inflamatórios) nos casos de menor gravidade, e nos animais que apresentam défices neurológicos de maior gravidade, o tratamento cirúrgico é o mais indicado. O prognóstico depende dos défices neurológicos manifestados pelo animal e da terapêutica instituída. A componente prática deste trabalho engloba a análise de 12 casos, correspondentes a cães submetidos a cirurgia descompressiva, devido a herniação do disco intervertebral na região toracolombar. A análise estatística descritiva foi realizada com base em dados recolhidos no Hospital Veterinário da UTAD (Vila Real, Portugal), entre o período de novembro de 2015 até maio de 2018. Os resultados obtidos permitiram concluir que as hérnias discais toracolombares têm maior expressão nas raças condrodistróficas (71%). Os machos inteiros foram os mais afetados (42%) e a idade de apresentação variou entre os 2 e os 8 anos com uma média de 5,17± 1,99 anos. A herniação por extrusão foi a mais frequente e o espaço intervertebral mais afetado foi L1-L2. A técnica descompressiva utilizada com maior frequência foi a pediculectomia. A média de dias necessários para o início do registo de melhorias do estado neurológico foi superior para os animais que se apresentaram com lesões medulares mais graves (grau IV a V). Dos 8 animais submetidos a reavaliação um mês após a cirurgia, 37,5% (3/8) recuperaram totalmente, 50% (4/8) manifestaram défices neurológicos mínimos e o animal classificado com grau V apresentou paraparesia ambulatória, ataxia e défices propriocetivos
Intervertebral disc herniation develops more frequently in the thoracolumbar region. Thoracolumbar herniation can occur in both chondrodystrophic and nonchondrodystrophic dog breeds, and it can occur by extrusion (Hansen type I) or protrusion (Hansen type II). Spinal cord injury caused by thoracolumbar intervertebral disc herniation may cause neurological deficits, ranging from local hyperaesthesia and ataxia to tetraplegia and loss of nociception. In order to classify the severity of the spinal cord injury, a clinical examination is required, which will correlate clinical signs with the results of the neurological examination, allowing the establishment of a prognosis. The diagnosis is essentially based on neurological examination and imaging, such as myelography, computed tomography or magnetic resonance. Therapy options include conservative treatment (rest and anti-inflammatory drugs) in mild cases, and in animals that present severe neurological deficits, the surgical treatment is more appropriate. The prognosis depends on the severity of the neurological deficits manifested by the animal and the therapeutics implemented. The practical component of this work includes the analysis of 12 cases corresponding to dogs undergoing decompressive surgery due to thoracolumbar disc herniation. The descriptive statistical analysis was performed based on data collected at the UTAD Veterinary Hospital (Vila Real, Portugal) between November 2015 and May 2018. The results revealed that thoracolumbar disc herniation is more frequent in chondrodystrophic breeds (71%). Male dogs were more affected (42%) and the age at onset ranged from 2 to 8 years with a mean age 5.17 ± 1.99 years. Herniation by extrusion was most frequent and the most affected intervertebral space was L1-L2. Pediculectomy was the most frequently used decompression technique. The mean number of days required to onset improvements in neurological status was higher for animals with severe spinal cord lesions (grade IV to V). In 8 animals submitted to reassessment, one month after surgery, 37.5% (3/8) had full neurologic recovering, 50% (4/8) showed minimal neurological deficits and the animal classified with grade V had ambulatory paraparesis, ataxia and proprioceptive deficits.
Intervertebral disc herniation develops more frequently in the thoracolumbar region. Thoracolumbar herniation can occur in both chondrodystrophic and nonchondrodystrophic dog breeds, and it can occur by extrusion (Hansen type I) or protrusion (Hansen type II). Spinal cord injury caused by thoracolumbar intervertebral disc herniation may cause neurological deficits, ranging from local hyperaesthesia and ataxia to tetraplegia and loss of nociception. In order to classify the severity of the spinal cord injury, a clinical examination is required, which will correlate clinical signs with the results of the neurological examination, allowing the establishment of a prognosis. The diagnosis is essentially based on neurological examination and imaging, such as myelography, computed tomography or magnetic resonance. Therapy options include conservative treatment (rest and anti-inflammatory drugs) in mild cases, and in animals that present severe neurological deficits, the surgical treatment is more appropriate. The prognosis depends on the severity of the neurological deficits manifested by the animal and the therapeutics implemented. The practical component of this work includes the analysis of 12 cases corresponding to dogs undergoing decompressive surgery due to thoracolumbar disc herniation. The descriptive statistical analysis was performed based on data collected at the UTAD Veterinary Hospital (Vila Real, Portugal) between November 2015 and May 2018. The results revealed that thoracolumbar disc herniation is more frequent in chondrodystrophic breeds (71%). Male dogs were more affected (42%) and the age at onset ranged from 2 to 8 years with a mean age 5.17 ± 1.99 years. Herniation by extrusion was most frequent and the most affected intervertebral space was L1-L2. Pediculectomy was the most frequently used decompression technique. The mean number of days required to onset improvements in neurological status was higher for animals with severe spinal cord lesions (grade IV to V). In 8 animals submitted to reassessment, one month after surgery, 37.5% (3/8) had full neurologic recovering, 50% (4/8) showed minimal neurological deficits and the animal classified with grade V had ambulatory paraparesis, ataxia and proprioceptive deficits.
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Dissertação de Mestrado Integrado em Medicina Veterinária apresentada à Universidade de Trás-os-Montes e Alto Douro
Palavras-chave
doença do disco intervertebral , hérnia , toracolombar , hemilaminectomia , pediculectomia , mini-hemilaminectomia , medula espinhal , cão