Computational development of a precise drilling guide for implant insertion in canine vertebral bodies / [Desenvolvimento computacional de um guia cirúrgico de perfuração precisa para inserção de implantes em corpo vertebral de cães]

O tratamento cirúrgico de estabilização da coluna vertebral de cães usualmente requer osteossíntese com uso de implantes, como pinos e parafusos. No entanto, as técnicas atuais de inserção de implantes no corpo vertebral não são totalmente precisas e várias complicações são atribuídas ao ato, como invasão do canal vertebral, danos vasculares e neurológicos. Para promover segurança na inserção de implantes e reduzir a ocorrência de lesões iatrogênicas, vem crescendo o interesse na produção de guias de perfuração em neurocirurgia veterinária. Com o objetivo de assegurar maior precisão e acurácia durante a perfuração óssea, foi desenvolvido um novo design de guia cirúrgico para inserção de implantes em corpo vertebral específico para a anatomia do paciente. A técnica proposta permite determinar o trajeto e o ângulo de perfuração óssea no corredor de implantação de cada vértebra, pela customização da guia e visa reduzir as taxas de complicações, promover precisão no posicionamento de implantes vertebrais e reduzir o tempo cirúrgico.

Vertebrectomia total e estabilização com pinos e polimetilmetacrilato como tratamento para luxação entre vértebras torácicas em cão ­ relato de caso / Total vertebrectomy and stabilization with pins and polymethylmethacrylate as treatment for thoracic vertebral luxation in a dog - case report

As lesões decorrentes de atropelamento são as principais causas de fraturas e luxações vertebrais, ocasionando graus variáveis de injúrias vertebrais e medulares. O presente trabalho tem como objetivo relatar a ocorrência de lesão traumática em coluna vertebral de cão sem raça definida, com quatro anos de idade, resultando em luxação T11-12, com exposição de T11 e secção medular, estando o paciente paraplégico, com sinais de lesão em neurônio motor superior e ausência de nocicepção profunda em membros pélvicos. O tratamento de escolha foi a vertebrectomia de T11, associada ao alinhamento de T10-12 com introdução de pinos e fixação com polimetilmetacrilato (PMMA) associado à ceftriaxona. Em decorrência de lesão na pleura parietal no trans-cirúrgico, optou-se pela toracostomia para introdução de tubo torácico, o qual permaneceu no paciente por quatro dias. No pós-operatório, o paciente apresentou recuperação satisfatória, sendo recomendado aos tutores a confecção de cadeira de rodas a fim de facilitar sua locomoção. A técnica mostrou-se satisfatória para minimizar as infecções passíveis de ocorrência em fraturas expostas, bem como melhorar a qualidade de vida do paciente, evitando-se dores crônicas.

Injuries resulting from being run over are the leading causes of vertebral fractures and dislocations, causing varying vertebral and spinal injuries. The present study aims to report the occurrence of traumatic injury to the spine of a mixed breed dog, aged four years, resulting in a T11-12 dislocation, with T11 exposure and spinal section, with the patient showing paraplegia, signs of an upper motor neuron lesion and absence of deep nociception in pelvic limbs. The treatment of choice was T11 vertebrectomy, associated with the alignment of T10-12 with the introduction of pins and fixation with polymethylmethacrylate (PMMA) associated with ceftriaxone. Due to a lesion in the parietal pleura during the surgery, thoracostomy was chosen to introduce a chest tube, which remained in the patient for four days. In the postoperative period, the patient presented a satisfactory recovery, and it was recommended that tutors make a wheelchair to facilitate their mobility. The technique proved to be satisfactory for minimizing infections that could occur in open fractures and improving the patient's quality of life, avoiding chronic pain.

Estabilização cirúrgica da coluna vertebral cervical em ovino / Cervical spinal cord surgical stabilization in a sheep

Background: Trauma is the main cause of spinal fractures and dislocations in humans and large animals. Clinical signspresent with acute onset and vary according to the location and severity of the spinal cord injury. The treatment of fractures in large animals depends on economic value, cost of procedures, prognosis, location and type of fracture. However,although spinal fractures in large animals are not uncommon, the literature about their clinical aspects and treatment isscanty. Therefore, the purpose of this report is to describe a surgical stabilization of atlantoaxial subluxation, fracture ofthe third cervical vertebra and C2-C3 subluxation.Case: An approximately 2-year-old Île-de-France sheep, weighing 101 kg, with a history of cervical trauma and nonambulatory tetraparesis was treated at the Veterinary Hospital of the Institution (UNIPAMPA). During physical examination, the animal presented good general physical condition and heart rate, respiratory rate and temperature was accordingto physiological parameters for the species. The animal remained in lateral decubitus, with minimal head and limb movements, and exhibited deep pain sensitivity. Clinical treatment with dexamethasone, limb physiotherapy and change inlateral decubitus position were employed, but failed to improve the animal’s condition. After five days of unresponsive toclinical treatment, the patient was referred to the neurology department, where it underwent neurological examination andradiographic examination of the cervical region was performed under general anesthesia. The radiographic examinationrevealed atlantoaxial subluxation, by displacement of the odontoid process into the vertebral canal, fracture of the thirdcervical vertebra and C2-C3 vertebral subluxation. The surgical planning aimed cervical vertebral instability repair usingatlantoaxial arthrodesis associated the stabilization of C1-C2 and C2-C3 vertebrae with Schanz pins and bone cement...

Estabilização cirúrgica da coluna vertebral cervical em ovino / Cervical spinal cord surgical stabilization in a sheep

Background: Trauma is the main cause of spinal fractures and dislocations in humans and large animals. Clinical signspresent with acute onset and vary according to the location and severity of the spinal cord injury. The treatment of fractures in large animals depends on economic value, cost of procedures, prognosis, location and type of fracture. However,although spinal fractures in large animals are not uncommon, the literature about their clinical aspects and treatment isscanty. Therefore, the purpose of this report is to describe a surgical stabilization of atlantoaxial subluxation, fracture ofthe third cervical vertebra and C2-C3 subluxation.Case: An approximately 2-year-old Île-de-France sheep, weighing 101 kg, with a history of cervical trauma and nonambulatory tetraparesis was treated at the Veterinary Hospital of the Institution (UNIPAMPA). During physical examination, the animal presented good general physical condition and heart rate, respiratory rate and temperature was accordingto physiological parameters for the species. The animal remained in lateral decubitus, with minimal head and limb movements, and exhibited deep pain sensitivity. Clinical treatment with dexamethasone, limb physiotherapy and change inlateral decubitus position were employed, but failed to improve the animals condition. After five days of unresponsive toclinical treatment, the patient was referred to the neurology department, where it underwent neurological examination andradiographic examination of the cervical region was performed under general anesthesia. The radiographic examinationrevealed atlantoaxial subluxation, by displacement of the odontoid process into the vertebral canal, fracture of the thirdcervical vertebra and C2-C3 vertebral subluxation. The surgical planning aimed cervical vertebral instability repair usingatlantoaxial arthrodesis associated the stabilization of C1-C2 and C2-C3 vertebrae with Schanz pins and bone cement...(AU)

Long-term clinical complications associated with the use of polymethyl methacrylate in spinal stabilization of dogs and cats: case series / Complicações clínicas de longo prazo relacionadas ao uso de pino ou parafuso/polimetilmetacrilato na estabilização espinhal de cães e gatos: série de casos

Vertebral and spinal cord trauma are common conditions in small animal practice and often result in vertebral fractures/luxation (VFL) with concomitant spinal cord laceration, concussion, compression, or ischemia. These lesions have several clinical presentations that may vary from moderate to severe pain and partial to total loss of motor, sensory, and visceral functions, which may result in death or euthanasia. Our purpose is to describe five cases (four dogs and one cat) of complications secondary to the use of bone cement for vertebral stabilization. The patients, between five months and four years of age and weighing between 1.4 and 12.2 kg, were referred to the Small Animal Orthopedics and Traumatology Service of the Veterinary Hospital of the College of Veterinary Medicine and Animal Science of the University of São Paulo. They had a history of post-operatory polymethyl methacrylate (PMMA) reactions (such as drainage or cement exposure due to infection or implant failure) in periods from 9 to 18 months after undergoing spinal osteosynthesis. Surgical implant removal occurred in 80% of the patients (4/5). Complete remission was not observed in the patient with residual implants. The association of pins/screws and PMMA is a versatile osteosynthesis technique and is applicable in all spinal regions. However, delayed complications can occur, which could require additional surgical procedures. Despite the small number of cases included in this study, one can infer that complications related to the use of bone cement in spinal surgery can occur in the long term and should be highlighted during the implant choosing process for vertebral osteosynthesis in small animals.

O trauma vertebromedular é uma afecção comum na rotina clínica de pequenos animais e resulta, muitas vezes, em fraturas e luxações vertebrais (FLV) associadas à laceração, concussão, compressão ou isquemia da medula espinhal. Essas lesões apresentam sinais clínicos que variam de dor moderada a grave, acompanhada por perda parcial ou total das funções motoras, sensoriais e viscerais, podendo resultar no óbito ou na indicação de eutanásia. O objetivo deste trabalho é descrever cinco casos de complicações inerentes o uso de cimento ósseo para estabilização vertebral em quatro cães e um gato. Os pacientes possuíam idades variando entre cinco meses a quatro anos, peso entre 1,4 e 12,2kg e foram atendidos no Serviço de Ortopedia e Traumatologia do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, com histórico de reações cutâneas ao polimetilmetacrilato (PMMA), como tratos drenantes ou exposição do cimento decorrente de infecção ou soltura precoce do implante, em períodos que variaram de nove à 18 meses após serem submetidos a osteossíntese da coluna vertebral. Foi realizada a remoção cirúrgica desses implantes em quatro pacientes e mantida a estabilização prévia em um caso. Houve resolução total do quadro de infecção nos pacientes em que se removeu o PMMA associada ao tratamento clínico, e remissão parcial no paciente em que o implante não pode ser removido. A utilização do cimento ósseo associado a parafusos ou pinos é uma técnica versátil e aplicável em todas as regiões da coluna vertebral, no entanto complicações tardias são possíveis, sendo necessário muitas vezes procedimentos cirúrgicos adicionais para a resolução do problema. Apesar da pequena quantidade de casos relatados, foi possível observar que complicações relacionadas ao uso do cimento ósseo na coluna vertebral podem ocorrer no médio ao longo prazo [...].

Long-term clinical complications associated with the use of polymethyl methacrylate in spinal stabilization of dogs and cats: case series / Complicações clínicas de longo prazo relacionadas ao uso de pino ou parafuso/polimetilmetacrilato na estabilização espinhal de cães e gatos: série de casos

Vertebral and spinal cord trauma are common conditions in small animal practice and often result in vertebral fractures/luxation (VFL) with concomitant spinal cord laceration, concussion, compression, or ischemia. These lesions have several clinical presentations that may vary from moderate to severe pain and partial to total loss of motor, sensory, and visceral functions, which may result in death or euthanasia. Our purpose is to describe five cases (four dogs and one cat) of complications secondary to the use of bone cement for vertebral stabilization. The patients, between five months and four years of age and weighing between 1.4 and 12.2 kg, were referred to the Small Animal Orthopedics and Traumatology Service of the Veterinary Hospital of the College of Veterinary Medicine and Animal Science of the University of São Paulo. They had a history of post-operatory polymethyl methacrylate (PMMA) reactions (such as drainage or cement exposure due to infection or implant failure) in periods from 9 to 18 months after undergoing spinal osteosynthesis. Surgical implant removal occurred in 80% of the patients (4/5). Complete remission was not observed in the patient with residual implants. The association of pins/screws and PMMA is a versatile osteosynthesis technique and is applicable in all spinal regions. However, delayed complications can occur, which could require additional surgical procedures. Despite the small number of cases included in this study, one can infer that complications related to the use of bone cement in spinal surgery can occur in the long term and should be highlighted during the implant choosing process for vertebral osteosynthesis in small animals.(AU)

O trauma vertebromedular é uma afecção comum na rotina clínica de pequenos animais e resulta, muitas vezes, em fraturas e luxações vertebrais (FLV) associadas à laceração, concussão, compressão ou isquemia da medula espinhal. Essas lesões apresentam sinais clínicos que variam de dor moderada a grave, acompanhada por perda parcial ou total das funções motoras, sensoriais e viscerais, podendo resultar no óbito ou na indicação de eutanásia. O objetivo deste trabalho é descrever cinco casos de complicações inerentes o uso de cimento ósseo para estabilização vertebral em quatro cães e um gato. Os pacientes possuíam idades variando entre cinco meses a quatro anos, peso entre 1,4 e 12,2kg e foram atendidos no Serviço de Ortopedia e Traumatologia do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, com histórico de reações cutâneas ao polimetilmetacrilato (PMMA), como tratos drenantes ou exposição do cimento decorrente de infecção ou soltura precoce do implante, em períodos que variaram de nove à 18 meses após serem submetidos a osteossíntese da coluna vertebral. Foi realizada a remoção cirúrgica desses implantes em quatro pacientes e mantida a estabilização prévia em um caso. Houve resolução total do quadro de infecção nos pacientes em que se removeu o PMMA associada ao tratamento clínico, e remissão parcial no paciente em que o implante não pode ser removido. A utilização do cimento ósseo associado a parafusos ou pinos é uma técnica versátil e aplicável em todas as regiões da coluna vertebral, no entanto complicações tardias são possíveis, sendo necessário muitas vezes procedimentos cirúrgicos adicionais para a resolução do problema. Apesar da pequena quantidade de casos relatados, foi possível observar que complicações relacionadas ao uso do cimento ósseo na coluna vertebral podem ocorrer no médio ao longo prazo [...].(AU)

Electromyographic evaluation of early stage results of exoscopic microdecompressive spinal surgery in dogs

Background: Spinal surgical interventions are generally used in the treatment of various spinal pathologiessuch as vertebral fracture, luxation-subluxation, congenital vertebral deformities, discal hernia, infection andtumor. Minimally invasive spinal surgery contributes to rapid recovery by reducing iatrogenic muscle damageand postoperative pain. In minimally invasive spinal surgery, a new hybrid imaging technique, the exoscope,has been developed in the last decade. The purpose of this study was to report efficacy of the exoscopic microdecompressive spinal surgery (MDSS) and its early postoperative electromyography (EMG) results in dogs.Materials, Methods & Results: The material of this study consisted of the owned 10 dogs with spinal cordinjury resulted from the different etiologies. On the basis of examinations, medical support (fluid therapy, corticosteroid, etc.) was applied to the required dogs. Exoscopic MDSS was performed under general anesthesia indogs. The neurologic, radiologic and EMG examination were completed at pre- and postoperative periods. EMGresults at postoperative 1st week showed increased conduction velocity and amplitudes in 3 cases. There was nosignificant change in a case. And, there was a slight slowdown in conduction velocity and significant decreasein amplitudes in a case. At postoperative 4th week, ther was increased conduction velocity and amplitudes in 8cases and needle EMG showed that spontan muscle activity was normal...

Electromyographic evaluation of early stage results of exoscopic microdecompressive spinal surgery in dogs

Background: Spinal surgical interventions are generally used in the treatment of various spinal pathologiessuch as vertebral fracture, luxation-subluxation, congenital vertebral deformities, discal hernia, infection andtumor. Minimally invasive spinal surgery contributes to rapid recovery by reducing iatrogenic muscle damageand postoperative pain. In minimally invasive spinal surgery, a new hybrid imaging technique, the exoscope,has been developed in the last decade. The purpose of this study was to report efficacy of the exoscopic microdecompressive spinal surgery (MDSS) and its early postoperative electromyography (EMG) results in dogs.Materials, Methods & Results: The material of this study consisted of the owned 10 dogs with spinal cordinjury resulted from the different etiologies. On the basis of examinations, medical support (fluid therapy, corticosteroid, etc.) was applied to the required dogs. Exoscopic MDSS was performed under general anesthesia indogs. The neurologic, radiologic and EMG examination were completed at pre- and postoperative periods. EMGresults at postoperative 1st week showed increased conduction velocity and amplitudes in 3 cases. There was nosignificant change in a case. And, there was a slight slowdown in conduction velocity and significant decreasein amplitudes in a case. At postoperative 4th week, ther was increased conduction velocity and amplitudes in 8cases and needle EMG showed that spontan muscle activity was normal...(AU)

Ex-vivo evaluation of the three-column concept in canine thoracolumbar fractures / [Avaliação em ex-vivo do conceito dos três compartimentos em fraturas toracolombares da coluna]

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.(AU)

Eventos traumáticos, como acidentes automobilísticos ou quedas, são muito comuns na medicina veterinária e, frequentemente, levam a fraturas ou luxações vertebrais, associadas a lesões medulares concomitantes, mais frequentemente na coluna toracolombar. O propósito deste estudo biomecânico em cadáveres foi determinar a viabilidade da teoria dos três compartimentos em fraturas induzidas em segmentos toracolombares de cães. Dezoito unidades espinhais funcionais (UEF) de segmentos toracolombares (T12-L2) foram coletadas de 18 cadáveres de cães adultos de médio porte e submetidas a testes de flexão-extensão e curvamento lateral, de modo que a amplitude de movimento (ADM) foi registrada com um goniômetro. Fraturas foram induzidas por meio de cargas compressivas aplicadas por uma máquina universal de ensaios (EMIC®). As amostras foram submetidas à tomografia computadorizada (TC), e as fraturas foram classificadas como afetando um, dois ou três compartimentos e divididas nos grupos A, B e C, respectivamente. A ADM pós-fratura foi comparada com os resultados prévios. Os grupos B e C (com fraturas em dois ou três compartimentos) apresentaram instabilidade nos dois eixos avaliados (P<0,05). Os resultados deste estudo corroboram a aplicabilidade da teoria dos três compartimentos para segmentos de coluna toracolombar em cães, uma vez que as UEF que sofreram as fraturas em dois ou mais compartimentos apresentaram instabilidade axial.(AU)

Ex-vivo evaluation of the three-column concept in canine thoracolumbar fractures / [Avaliação em ex-vivo do conceito dos três compartimentos em fraturas toracolombares da coluna]

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.(AU)

Eventos traumáticos, como acidentes automobilísticos ou quedas, são muito comuns na medicina veterinária e, frequentemente, levam a fraturas ou luxações vertebrais, associadas a lesões medulares concomitantes, mais frequentemente na coluna toracolombar. O propósito deste estudo biomecânico em cadáveres foi determinar a viabilidade da teoria dos três compartimentos em fraturas induzidas em segmentos toracolombares de cães. Dezoito unidades espinhais funcionais (UEF) de segmentos toracolombares (T12-L2) foram coletadas de 18 cadáveres de cães adultos de médio porte e submetidas a testes de flexão-extensão e curvamento lateral, de modo que a amplitude de movimento (ADM) foi registrada com um goniômetro. Fraturas foram induzidas por meio de cargas compressivas aplicadas por uma máquina universal de ensaios (EMIC®). As amostras foram submetidas à tomografia computadorizada (TC), e as fraturas foram classificadas como afetando um, dois ou três compartimentos e divididas nos grupos A, B e C, respectivamente. A ADM pós-fratura foi comparada com os resultados prévios. Os grupos B e C (com fraturas em dois ou três compartimentos) apresentaram instabilidade nos dois eixos avaliados (P<0,05). Os resultados deste estudo corroboram a aplicabilidade da teoria dos três compartimentos para segmentos de coluna toracolombar em cães, uma vez que as UEF que sofreram as fraturas em dois ou mais compartimentos apresentaram instabilidade axial.(AU)

Steinmann pins and polymethylmethacrylate repair of fourth lumbar vertebral fracture and dorsocranial luxation in puppy

Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog. Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability...

Steinmann pins and polymethylmethacrylate repair of fourth lumbar vertebral fracture and dorsocranial luxation in puppy

Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog. Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability...(AU)

Fraturas e luxações vertebrais em cães / Vertebral fractures and luxation in dogs

Background: Vertebral fractures and luxations (VFL) are a major cause of neurologic injury in small animals. They aremost commonly associated with severe external trauma from road traffic accidents, aggression, or falls from heights. Therewere few studies concerning VFL, mainly on results of treatments and sequelae. This retrospective work aimed to studypatients with extrinsic trauma in the spinal cord that were treated at the Neurology and Neurosurgery Service of a HigherEducation Institution in Brazil from 2007 to 2018, describing main etiologies, location of lesion, degree of neurologicaldysfunction, treatment, results and sequelae after surgical or conservative therapy.Materials, Methods & Results: One hundred and nine dogs of various breed and ages were included in this study. Themain etiology of the spinal cord injury in these dogs were fractures and/or dislocations caused by road traffic accidents(66%), followed by interaction with other animals (5.5%). The body region most frequently affected by the lesions were thethoracolumbar segment (T3-L3) of the vertebral spine (52.3%), followed the lumbosacral segment [L4-S3] (38.5%). Thedegrees of the most prevalent neurological dysfunctions for each of the segments were grade V in 73.7% of the dogs withlesions between T3-L3, and grade III in 54.8% of the dogs with lesions in L4-S3. Twenty-one tutors of dogs subjected tosurgery and 20 tutors of dogs that underwent clinical treatment could be contacted by phone. Statistical analysis performedon data from these patients indicated that there was no significant correlation between the motor recovery and the type oftreatment instituted. However, when the degree of motor dysfunction was analyzed in conjunction with recovery, mildergrades were found to be accompanied by the best recovery results.Discussion: Road traffic accidents were the most common cause of damage to the spinal cord, a finding described inother studies on...

Fraturas e luxações vertebrais em cães / Vertebral fractures and luxation in dogs

Background: Vertebral fractures and luxations (VFL) are a major cause of neurologic injury in small animals. They aremost commonly associated with severe external trauma from road traffic accidents, aggression, or falls from heights. Therewere few studies concerning VFL, mainly on results of treatments and sequelae. This retrospective work aimed to studypatients with extrinsic trauma in the spinal cord that were treated at the Neurology and Neurosurgery Service of a HigherEducation Institution in Brazil from 2007 to 2018, describing main etiologies, location of lesion, degree of neurologicaldysfunction, treatment, results and sequelae after surgical or conservative therapy.Materials, Methods & Results: One hundred and nine dogs of various breed and ages were included in this study. Themain etiology of the spinal cord injury in these dogs were fractures and/or dislocations caused by road traffic accidents(66%), followed by interaction with other animals (5.5%). The body region most frequently affected by the lesions were thethoracolumbar segment (T3-L3) of the vertebral spine (52.3%), followed the lumbosacral segment [L4-S3] (38.5%). Thedegrees of the most prevalent neurological dysfunctions for each of the segments were grade V in 73.7% of the dogs withlesions between T3-L3, and grade III in 54.8% of the dogs with lesions in L4-S3. Twenty-one tutors of dogs subjected tosurgery and 20 tutors of dogs that underwent clinical treatment could be contacted by phone. Statistical analysis performedon data from these patients indicated that there was no significant correlation between the motor recovery and the type oftreatment instituted. However, when the degree of motor dysfunction was analyzed in conjunction with recovery, mildergrades were found to be accompanied by the best recovery results.Discussion: Road traffic accidents were the most common cause of damage to the spinal cord, a finding described inother studies on...(AU)

Estabilização vertebral segmentar modificada no tratamento de trauma medular em ouriço-cacheiro (Coendou spinosus): relato de caso / Modified segmental vertebral stabilization in the treatment of spinal cord trauma in a Paraguaian hairy dwarf porcupine (Coendou spinosus): case report

Uma fêmea, adulta, de ouriço-cacheiro (Coendou spinosus, F. Cuvier, 1823), foi atendida com histórico de trauma medular. No exame neurológico, foi constatada paraplegia com nocicepção preservada e sinais compatíveis com choque espinhal. Exame radiográfico e mielografia apontaram presença de fratura e luxação vertebral torácica entre T10-11. O paciente foi submetido à técnica de estabilização vertebral segmentar modificada, com pinos de Steinmann e fios de cerclagem. A técnica utilizada mostrou-se eficaz na estabilização da fratura/luxação vertebral e na recuperação dos sinais neurológicos. O paciente apresentou recuperação progressiva da deambulação. Para o conhecimento dos autores, este é o primeiro relato utilizando estabilização vertebral segmentar modificada para o tratamento de fratura/luxação vertebral torácica em Coendou spinosus.(AU)

An female, adult Paraguayan hairy dwarf porcupine (Coendou spinosus, F. Cuvier, 1823) was referred to the Veterinary Hospital with clinical history of spinal cord injury. In the neurological examination, paraplegia with preserved nociception compatible with signs of spinal shock were observed. Radiographic and myelographic examinations showed evidence of a vertebral dislocation and fracture between the 10th and 11th thoracic vertebrae. The patient underwent surgical stabilization of the lesion using the modified segmental vertebral stabilization technique with Steinmann pins and cerclage wires. Under the conditions reported in this case, the technique was effective in stabilizing vertebral fracture/dislocation and in recovering neurological functions. The patient presented progressive recovery from ambulation. To the authors' knowledge, this is the first case report that performed modified segment stabilization for thoracic vertebral fracture/luxation treatment in Coendou spinosus.(AU)

Estabilização vertebral segmentar modificada no tratamento de trauma medular em ouriço-cacheiro (Coendou spinosus): relato de caso / Modified segmental vertebral stabilization in the treatment of spinal cord trauma in a Paraguaian hairy dwarf porcupine (Coendou spinosus): case report

Uma fêmea, adulta, de ouriço-cacheiro (Coendou spinosus, F. Cuvier, 1823), foi atendida com histórico de trauma medular. No exame neurológico, foi constatada paraplegia com nocicepção preservada e sinais compatíveis com choque espinhal. Exame radiográfico e mielografia apontaram presença de fratura e luxação vertebral torácica entre T10-11. O paciente foi submetido à técnica de estabilização vertebral segmentar modificada, com pinos de Steinmann e fios de cerclagem. A técnica utilizada mostrou-se eficaz na estabilização da fratura/luxação vertebral e na recuperação dos sinais neurológicos. O paciente apresentou recuperação progressiva da deambulação. Para o conhecimento dos autores, este é o primeiro relato utilizando estabilização vertebral segmentar modificada para o tratamento de fratura/luxação vertebral torácica em Coendou spinosus.(AU)

An female, adult Paraguayan hairy dwarf porcupine (Coendou spinosus, F. Cuvier, 1823) was referred to the Veterinary Hospital with clinical history of spinal cord injury. In the neurological examination, paraplegia with preserved nociception compatible with signs of spinal shock were observed. Radiographic and myelographic examinations showed evidence of a vertebral dislocation and fracture between the 10th and 11th thoracic vertebrae. The patient underwent surgical stabilization of the lesion using the modified segmental vertebral stabilization technique with Steinmann pins and cerclage wires. Under the conditions reported in this case, the technique was effective in stabilizing vertebral fracture/dislocation and in recovering neurological functions. The patient presented progressive recovery from ambulation. To the authors' knowledge, this is the first case report that performed modified segment stabilization for thoracic vertebral fracture/luxation treatment in Coendou spinosus.(AU)

Avaliação sensitiva, motora e cistométrica de cães com lesão medular crônica, submetidos ao transplante de células-tronco mesenquimais derivadas de tecido adiposo / Sensory, motor and cystometric evaluation of dogs with chronic spinal cord injury submitted to mesenchymal stem cell transplantation

A utilização de células-tronco na reparação de lesões tem sido extensivamente investigada. Neste estudo, examinamos os efeitos terapêuticos de dois transplantes (12x106 céls/transplante) de células-tronco mesenquimais alogênicas derivadas do tecido adiposo (CTDAs) em 11 cães com lesões crônicas traumáticas toracolombares da medula espinhal. As CTDAs foram foram cultivadas in vitro, a proliferação e a viabilidade foram avaliadas. As suspensões foram expandidas e administradas no espaço intradural com intervalo de uma semana entre transplantes. Os cães foram submetidos à avaliações clínicas, laboratoriais, radiográficas, tomográficas, sensitivas, motoras e cistométricas. A maioria dos animais não tinha raça definida (63,63%), mesma proporção para o acometimento de fêmeas e foi observada predominância de fratura com subluxação vertebral (81,81%). Na comparação dos cães pré e pós-transplante não foram observadas alterações hematológicas e três animais (27,27%) apresentaram cistite bacteriana. Em relação a sensibilidade, motricidade e cistometria, também não houve alterações significativas dos índices antes e pós transplantes, sendo observado a ausência nociceptiva na maioria dos animais (72,73%), paraplegia e incontinência urinária na mesma proporção. Neste estudo concluiu-se que o protocolo utilizado de transplante de CTDAs, demonstrou ser um tratamento seguro para cães com lesão medular crônica, com melhora discreta da funcionalidade vesical, porém sem melhora clínica significativa.(AU)

The use of stem cells in injury repair has been extensively investigated. In this study, we examined the therapeutic effects of two transplants (12x106 cells/transplantation) of allogenic adipose-derived stem cells (ASCs) in 11 dogs with chronic spinal cord injury. ASC were cultured in vitro, proliferation and cell viability were evaluated. Cell suspensions were prepared and administered in the intradural space, with a one-week interval between transplants. The animals were submitted to clinical, laboratory, radiographic, tomographic, sensory, motor and cystometric evaluations. Most of the animals were not a breed defined (63.63%), the same proportion for females affected, predominance of vertebral subluxation fracture was observed (81.81%). Before and after the transplants no hematological changes were observed, three animals (27.27%) presented bacterial cystitis, and in relation to motor, cystometry and sensitivity, no improvement was observed; the rates were maintained before and after transplants, predominance of nociceptive absence in most animals (72.73%), and paraplegia and urinary incontinence in the same proportion. In this study it was concluded that the use of ADSCs for the treatment of dogs with chronic spinal cord injury is safe, with a slight improvement in bladder function, but without significantly clinical improvement.(AU)

Avaliação sensitiva, motora e cistométrica de cães com lesão medular crônica, submetidos ao transplante de células-tronco mesenquimais derivadas de tecido adiposo / Sensory, motor and cystometric evaluation of dogs with chronic spinal cord injury submitted to mesenchymal stem cell transplantation

A utilização de células-tronco na reparação de lesões tem sido extensivamente investigada. Neste estudo, examinamos os efeitos terapêuticos de dois transplantes (12x106 céls/transplante) de células-tronco mesenquimais alogênicas derivadas do tecido adiposo (CTDAs) em 11 cães com lesões crônicas traumáticas toracolombares da medula espinhal. As CTDAs foram foram cultivadas in vitro, a proliferação e a viabilidade foram avaliadas. As suspensões foram expandidas e administradas no espaço intradural com intervalo de uma semana entre transplantes. Os cães foram submetidos à avaliações clínicas, laboratoriais, radiográficas, tomográficas, sensitivas, motoras e cistométricas. A maioria dos animais não tinha raça definida (63,63%), mesma proporção para o acometimento de fêmeas e foi observada predominância de fratura com subluxação vertebral (81,81%). Na comparação dos cães pré e pós-transplante não foram observadas alterações hematológicas e três animais (27,27%) apresentaram cistite bacteriana. Em relação a sensibilidade, motricidade e cistometria, também não houve alterações significativas dos índices antes e pós transplantes, sendo observado a ausência nociceptiva na maioria dos animais (72,73%), paraplegia e incontinência urinária na mesma proporção. Neste estudo concluiu-se que o protocolo utilizado de transplante de CTDAs, demonstrou ser um tratamento seguro para cães com lesão medular crônica, com melhora discreta da funcionalidade vesical, porém sem melhora clínica significativa.(AU)

The use of stem cells in injury repair has been extensively investigated. In this study, we examined the therapeutic effects of two transplants (12x106 cells/transplantation) of allogenic adipose-derived stem cells (ASCs) in 11 dogs with chronic spinal cord injury. ASC were cultured in vitro, proliferation and cell viability were evaluated. Cell suspensions were prepared and administered in the intradural space, with a one-week interval between transplants. The animals were submitted to clinical, laboratory, radiographic, tomographic, sensory, motor and cystometric evaluations. Most of the animals were not a breed defined (63.63%), the same proportion for females affected, predominance of vertebral subluxation fracture was observed (81.81%). Before and after the transplants no hematological changes were observed, three animals (27.27%) presented bacterial cystitis, and in relation to motor, cystometry and sensitivity, no improvement was observed; the rates were maintained before and after transplants, predominance of nociceptive absence in most animals (72.73%), and paraplegia and urinary incontinence in the same proportion. In this study it was concluded that the use of ADSCs for the treatment of dogs with chronic spinal cord injury is safe, with a slight improvement in bladder function, but without significantly clinical improvement.(AU)

Desenvolvimento de caminhar espinal em cães paraplégicos com fraturas e luxações vertebrais toracolombares / Development of spinal walking in paraplegic dogs with thoracolumbar spinal fractures/luxations

Fraturas e luxações vertebrais (FLV) toracolombares estão dentre as afecções neurológicas mais frequentes na neurologia veterinária. São um dos distúrbios mais graves e desafiadores, devido ao elevado risco de paralisia permanente, levando muitos animais a serem submetidos à eutanásia, devido ao prognóstico desfavorável nos animais que perderam a nocicepção. Objetivou-se descrever as bases neurofisiológicas responsáveis pelo desenvolvimento do caminhar espinal e analisar, em 37 cães acometidos por FLV toracolombares, os dados referentes à taxa de recuperação dos animais com e sem nocicepção. Naqueles sem nocicepção, analisou-se ainda a frequência dos animais que desenvolveram caminhar espinal e o período médio para seu aparecimento. Em relação ao grau da lesão a as taxas de recuperação, 14/37 animais (37,8%) possuíam nocicepção, no qual a taxa de recuperação da deambulação voluntaria e das funções viscerais foi de 100%. Enquanto que 23/37 animais (62,1%) perderam a nocicepção, no qual nenhum recuperou a deambulação voluntária, ocorrendo morte por causas diversas em sete destes. Dos 16 animais sem nocicepção sobreviventes e que foram submetidos ao tratamento conservativo ou cirúrgico, cinco (31,25%) readquiriram a capacidade de caminhar (tempo médio de 115 dias) sem recuperar a nocicepção, sendo esta deambulação involuntária atribuída ao caminhar espinal. De acordo com os resultados desta pesquisa, o parâmetro isolado da perda da nocicepção não deve desencorajar a realização da terapia, pois em cães paraplégicos com FLV toracolombares, há possibilidade de ocorrer desenvolvimento de deambulação involuntária.(AU)

Thoracolumbar vertebral fractures and luxations (VFL) are one of the most common neurological disorders in veterinary neurology and one of the most serious and challenging disorders due to the high risk of permanent paralysis, leading many dogs to be euthanized without treatment due to the reports of unfavorable prognosis about ambulation in animals that lost nociception. This study aimed to describe the neurophysiologic bases responsible for the development of the spinal walking and examine in 37 dogs affected with thoracolumbar VFL, data relating to the recovery rate of animals with and without nociceptionIn those without nociception was analyzed the frequency of the spinal walking animals that developed for its appearance, and the average period was established. Regarding the degree of injury to recovery rates, 14/37 dogs (37.8%) had nociception, in which the rate of recovery of voluntary ambulation was 100%. While 23/37 dogs (62.1%) lost the nociception, where no voluntary ambulation was regained ambulation, occurred death from various causes in seven of these. From 16 dogs without nociception and survivors who underwent conservative or surgical treatment, five (31.25%) regained the ability to walk without regaining nociception; this was attributed to spinal walking, where the average time for their development was 115 days. According to the results of this study, the single parameter of loss of the nociception should not discourage the therapy, as paraplegic dogs with thoracolumbar VFL can develop involuntary ambulation.(AU)

Desenvolvimento de caminhar espinal em cães paraplégicos com fraturas e luxações vertebrais toracolombares / Development of spinal walking in paraplegic dogs with thoracolumbar spinal fractures/luxations

Fraturas e luxações vertebrais (FLV) toracolombares estão dentre as afecções neurológicas mais frequentes na neurologia veterinária. São um dos distúrbios mais graves e desafiadores, devido ao elevado risco de paralisia permanente, levando muitos animais a serem submetidos à eutanásia, devido ao prognóstico desfavorável nos animais que perderam a nocicepção. Objetivou-se descrever as bases neurofisiológicas responsáveis pelo desenvolvimento do caminhar espinal e analisar, em 37 cães acometidos por FLV toracolombares, os dados referentes à taxa de recuperação dos animais com e sem nocicepção. Naqueles sem nocicepção, analisou-se ainda a frequência dos animais que desenvolveram caminhar espinal e o período médio para seu aparecimento. Em relação ao grau da lesão a as taxas de recuperação, 14/37 animais (37,8%) possuíam nocicepção, no qual a taxa de recuperação da deambulação voluntaria e das funções viscerais foi de 100%. Enquanto que 23/37 animais (62,1%) perderam a nocicepção, no qual nenhum recuperou a deambulação voluntária, ocorrendo morte por causas diversas em sete destes. Dos 16 animais sem nocicepção sobreviventes e que foram submetidos ao tratamento conservativo ou cirúrgico, cinco (31,25%) readquiriram a capacidade de caminhar (tempo médio de 115 dias) sem recuperar a nocicepção, sendo esta deambulação involuntária atribuída ao caminhar espinal. De acordo com os resultados desta pesquisa, o parâmetro isolado da perda da nocicepção não deve desencorajar a realização da terapia, pois em cães paraplégicos com FLV toracolombares, há possibilidade de ocorrer desenvolvimento de deambulação involuntária.(AU)

Thoracolumbar vertebral fractures and luxations (VFL) are one of the most common neurological disorders in veterinary neurology and one of the most serious and challenging disorders due to the high risk of permanent paralysis, leading many dogs to be euthanized without treatment due to the reports of unfavorable prognosis about ambulation in animals that lost nociception. This study aimed to describe the neurophysiologic bases responsible for the development of the spinal walking and examine in 37 dogs affected with thoracolumbar VFL, data relating to the recovery rate of animals with and without nociceptionIn those without nociception was analyzed the frequency of the spinal walking animals that developed for its appearance, and the average period was established. Regarding the degree of injury to recovery rates, 14/37 dogs (37.8%) had nociception, in which the rate of recovery of voluntary ambulation was 100%. While 23/37 dogs (62.1%) lost the nociception, where no voluntary ambulation was regained ambulation, occurred death from various causes in seven of these. From 16 dogs without nociception and survivors who underwent conservative or surgical treatment, five (31.25%) regained the ability to walk without regaining nociception; this was attributed to spinal walking, where the average time for their development was 115 days. According to the results of this study, the single parameter of loss of the nociception should not discourage the therapy, as paraplegic dogs with thoracolumbar VFL can develop involuntary ambulation.(AU)