Biomechanical study of partial lateral corpectomy with or without an association with pediculectomy and hemilaminectomy in canine specimens / Estudo biomecânico de corpectomia lateral parcial com ou sem associação com pediculectomia e hemilaminectomia em espécimes caninos

The present objective was to increase the number of biomechanical cycles performed using non-chondrodystrophic dog specimens, based on the study by Araújo (2017), comparing partial lateral corpectomy (PLC) alone, corpectomy and pediculectomy, and PLC associated with pediculectomy and hemilaminectomy to determine if there are significant differences between them regarding deformation versus applied force. Groups were divided as: control (G1), corpectomy (G2), corpectomy +pediculectomy (G3), and corpectomy + pediculectomy + hemilaminectomy (G4). The level of displacement versus force was observed during axial compression, flexion, extension, right and left lateral bending, and right and left axial rotation. Significant differences were observed between groups for flexion, extension, right and left axial rotation, and left lateral bending, whereas there was no difference for axial compression and right lateral bending. PLC and PLC with pediculectomy had significant differences in flexion and in extension, similar to PLC associated with pediculectomy and with hemilaminectomy in right and left axial rotation, flexion, extension, and right lateral bending.

O presente objetivo foi, a partir de grupos de espécimes caninas não condrodistróficas, aumentar o número de ciclos biomecânicos realizados, com base no estudo de Araújo (2017), comparando-se corpectomia parcial lateral (CPL) isolada, corpectomia e pediculectomia, à CPL associada à pediculectomia e à hemilaminectomia, no intuito de determinar se há diferenças significativas entre eles quanto à deformação versus à força aplicada. Os grupos foram divididos em: controle (G1), corpectomia (G2), corpectomia + pediculectomia (G3) e corpectomia + pediculectomia + hemilaminectomia (G4). O nível de deslocamento versus a força foi observado durante a compressão axial, a flexão, a extensão, a flexão lateral direita e esquerda e a rotação axial direita e esquerda. Observaram-se diferenças significativas entre os grupos para flexão, extensão, rotação axial direita e esquerda e flexão lateral esquerda, ao passo que, na compressão axial e na flexão lateral direita, não houve diferença. CPL e CPL com pediculectomia tiveram diferenças significativas na flexão e na extensão, semelhantemente à CPL associada à pediculectomia e à hemilaminectomia nos movimentos de rotação axial direita e esquerda, flexão, extensão e flexão lateral direita.

Association between spinal cord compression ratio in magnetic resonance imaging, initial neurological status, and recovery after ventral slot in 57 dogs with cervical disc extrusion.

This retrospective, unblinded, single rater study evaluated images obtained from magnetic resonance imaging (MRI) of dogs with cervical intervertebral disc extrusion before being submitted to ventral slot decompression (VSD). Dogs were re-evaluated systematically at 10 and 30 days after VSD. The objectives of this study were to investigate the associations between the following parameters: (1) The maximal spinal cord compression ratio (SCCR) as seen on transverse MRI and pre-surgical neurological status (NS) grade; we hypothesized that dogs with greater SCCR will have worse pre-surgical NS grade at presentation; (2) Pre-surgical NS grade and postoperative recovery; we hypothesized that worse pre-surgical NS grade will be associated with longer postoperative recovery time; (3) SCCR and postoperative recovery; we hypothesized that dogs with higher SCCR will have longer recovery time; (4) Location of extrusion (cranial vs. caudal) and initial NS grade and outcomes; we hypothesized that caudal cervical extrusion will have worse NS grade and longer time to recovery; (5) Longitudinal extension of ventral CSF signal loss on HASTE pulse sequence and NS grade and time to recovery; we hypothesized that dogs with longer HASTE CSF attenuation will have higher NS grade and longer time to recovery. There was no significant association between SCCR and NS grade, suggesting that this relationship in the cervical region is similar to what is observed in the thoracolumbar region, rejecting our first hypothesis. There was a significant difference between ambulatory tetraparesis dogs versus non-ambulatory tetraparesis dogs regarding complete recovery at 10 days: dogs with NS grade 1, 2, or 3 overall recovered faster than dogs with NS grade 4. However, there was no significant difference between these groups regarding complete recovery at 30 days, thereby accepting our second hypothesis at 10 days and rejecting it at 30 days. There was no correlation between SCCR and recovery time, rejecting our third hypothesis. Caudal cervical extrusion did not show higher NS grade or longer recovery time than cranial extrusion, rejecting our fourth hypothesis. CSF attenuation length ratio on HASTE images was not significantly correlated with NS grade but weakly correlate with post-surgical recovery time, partially accepting our fifth hypothesis.

Genetics of intervertebral disc disease: A review.

Intervertebral disc disease (IVDD) is a common musculoskeletal disease affecting about 5% of all individuals. It is characterized by lumbar disc herniation, which causes nerve root irritation, either mechanically or via inflammatory mediators, and results in radiating pain, known as sciatica. Numerous studies have been conducted to identify the causes and risk factors for IVDD. Lifting heavy loads, torsional stress, and motor vehicle driving are among the best-identified environmental risk factors. However, it has become evident recently from family and twin studies that genetic factors may also be important in IVDD. This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation. In addition, disc degeneration has been shown to be related to an aggrecan gene polymorphism, a Vitamin D receptor and matrix metalloproteinase-3 gene alleles. This review highlights the genetic role and occupational aspects of IVDD.

Focal spinal hyperesthesia as a prognostic factor in paraplegic dogs without deep pain perception / Hiperestesia espinhal focal como fator prognóstico em cães paraplégicos sem percepção de dor profunda

Intervertebral disc extrusion (IVDE) is the most common cause of spinal cord compression in dogs, whose prognosis is variable and depends on several factors, with deep pain perception (DPP) being the main parameter used. Investigations of new prognostic factors are studied to assist in the estimation of functional recovery. Thus, this study aimed to evaluate whether spinal hyperesthesia (SH) at the compression site can be used as a prognostic factor for the functional recovery of dogs with acute IVDE (Hansen type I), without DPP being subjected to thoracolumbar hemilaminectomy. Decompression surgery was performed on the same day or the day after admission. The duration of the loss of DPP until surgery performance ranged from 1 to 60 days, with a median of 4.5 days for the group of dogs with SH and 5.5 days for those without SH. Among the 68 dogs included in this retrospective study, 73.5% (50/68) showed SH, and 26.5% (18/68) were not identified. Recovery was satisfactory in 60% (30/50) of dogs with SH and in 27.7% (5/18) of dogs without SH, demonstrating that paraplegic dogs without DPP but with SH were 3.9 times more likely to recover when compared to dogs in the same condition, but with no SH. No studies have evaluated SH by palpation of the spine as a prognostic factor, which reinforces the relevance of the present study. The results of this study imply that SH in paraplegic dogs affected by thoracolumbar IVDE, without the presence of DPP, can be used as a possible prognostic indicator of functional recovery.

A extrusão do disco intervertebral (EDIV) é a causa mais comum de lesão compressiva na medula espinhal de cães, cujo prognóstico é variável e depende de diversos fatores, sendo a percepção de dor profunda (PDP) o principal parâmetro utilizado. Pesquisas de novos fatores prognósticos são estudados com intuito de auxiliar na estimativa mais precisa de recuperação funcional. Com isso, o objetivo do estudo foi avaliar se a hiperestesia espinhal (HE) no local da compressão, pode ser utilizada como um fator prognóstico para recuperação funcional de cães com extrusão aguda do disco intervertebral (Hansen tipo I), sem a presença de PDP submetidos a hemilaminectomia toracolombar. A cirurgia descompressiva ocorreu no mesmo dia ou no dia seguinte ao atendimento. A duração da perda de dor profunda até a realização da cirurgia variou de 1 a 60 dias, com uma mediana de 4,5 dias para o grupo de cães com e 5,5 dias para aqueles sem hiperestesia espinhal. Dos 68 cães incluídos nesse estudo retrospectivo, 73,5% (50/68) apresentavam HE e, em 26,5% (18/68) a dor não foi identificada. A recuperação foi satisfatória nos cães com HE em 60% (30/50) e, sem HE, em 27,7% (5/18) dos casos, demonstrando que os cães paraplégicos sem PDP, mas com presença de hiperestesia espinhal tem 3,9 vezes mais chances de recuperação quando comparado com cães na mesma condição, mas sem HE. Não foram encontrados trabalhos que avaliaram a HE mediante a palpação da coluna vertebral como um fator prognóstico, o que reforça a relevância do presente estudo. Os resultados do presente trabalho sugerem que a HE em cães paraplégicos acometidos por EDIV toracolombar sem presença de PDP pode ser utilizada como um possível indicador prognóstico de recuperação funcional.

Extrusão de disco intervertebral intradural em um cão / Intradural disc extrusion in a dog

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localizationof the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusionat a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intraduralintervertebral disc extrusion not preceded by a traumatic event.Case: A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysispreceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscletone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal onthe right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographsof the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourthlumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4.Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease wassuspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material.The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord andremoved. Subsequent histopathological...(AU)

Clinical management of dogs with presumptive diagnosis of cervical intervertebral disc disease: 78 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral cervical: 78 casos (2006-2017)

This study aimed to identify dogs with a presumptive diagnosis of cervical intervertebral disc disease (IVDD; C1-C5 or C6-T2) submitted to clinical management and evaluate the outcome. This study also aimed to demonstrate the age, sex, and treatment response according to the neurological degree, and verify whether those factors could potentially influence the outcome. The data were obtained from patients with a neurological dysfunction, admitted at the Veterinary Hospital from January 2006 to March 2017. In addition to patient records, the tutors answered a questionnaire related to the success of therapy. A hundred and seventy-seven neurological records were evaluated, and 78 were included in the study according to the inclusion criteria. The most frequent breeds were Dachshunds, followed by mixed-breed dogs. Regarding the neurological dysfunction degree, 58.97% presented grade I (only neck pain), 25.64% were grade II (ambulatory tetraparesis), and 15.38% grade III (nonambulatory tetraparesis). Absolute and partial space rest were performed in 75.64% and 24.36% of the cases, respectively. The minimum rest time was one week and could come up to four weeks. Most dogs were small-sized (≤15kg). The recovery was satisfactory in 87.17% of dogs and unsatisfactory in 12.83%. Regarding recurrence, we observed that 10.3% of dogs presented satisfactory recovery. The clinical treatment for dogs with cervical IVDD can be indicated with adequate clinical response to dysfunction degrees ranging from I to III, either at rest or in restricted space and with a low rate of relapse.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de doença do disco intervertebral cervical (DDIV; C1-C5 ou C6-T2) submetidos ao tratamento clínico e avaliar a resposta a terapia instituída e o índice de recidiva. Esse estudo também visou demonstrar a idade, o gênero e a resposta ao tratamento de acordo com o grau neurológico, a fim de verificar se esses parâmetros podem ser utilizados como fatores prognósticos para a evolução clínica desses pacientes. Foram revisados os registros neurológicos do Hospital Veterinário Universitário de janeiro de 2006 a março de 2017. Realizaram coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Avaliaram 177 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 78 delas. As raças mais frequentes foram Dachshunds, seguido dos cães sem raça definida. Quanto ao grau de disfunção neurológica, 58,97% apresentavam grau I (somente dor), 25,64% estavam em grau II (tetraparesia ambulatória) e 15,38% em grau III (tetraparesia não ambulatória). O repouso absoluto e em espaço restrito foram realizados em 75,64% e 24,36% dos casos, respectivamente e com duração de no mínimo uma semana, podendo chegar a mais de quatro semanas. A maioria dos animais era de pequeno porte (≤15kg). A recuperação foi satisfatória em 87,17% dos cães e insatisfatória em 12,83%. Quanto à recidiva, esta foi observada em 10,3% dos pacientes com recuperação satisfatória. O tratamento clínico para cães com DDIV cervical pode ser indicado com adequada resposta clínica para graus de disfunção que variam de I a III, seja em repouso absoluto ou em espaço restrito e com baixo índice de recidiva.(AU)

Clinical management of dogs with presumptive diagnosis of cervical intervertebral disc disease: 78 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral cervical: 78 casos (2006-2017)

This study aimed to identify dogs with a presumptive diagnosis of cervical intervertebral disc disease (IVDD; C1-C5 or C6-T2) submitted to clinical management and evaluate the outcome. This study also aimed to demonstrate the age, sex, and treatment response according to the neurological degree, and verify whether those factors could potentially influence the outcome. The data were obtained from patients with a neurological dysfunction, admitted at the Veterinary Hospital from January 2006 to March 2017. In addition to patient records, the tutors answered a questionnaire related to the success of therapy. A hundred and seventy-seven neurological records were evaluated, and 78 were included in the study according to the inclusion criteria. The most frequent breeds were Dachshunds, followed by mixed-breed dogs. Regarding the neurological dysfunction degree, 58.97% presented grade I (only neck pain), 25.64% were grade II (ambulatory tetraparesis), and 15.38% grade III (nonambulatory tetraparesis). Absolute and partial space rest were performed in 75.64% and 24.36% of the cases, respectively. The minimum rest time was one week and could come up to four weeks. Most dogs were small-sized (≤15kg). The recovery was satisfactory in 87.17% of dogs and unsatisfactory in 12.83%. Regarding recurrence, we observed that 10.3% of dogs presented satisfactory recovery. The clinical treatment for dogs with cervical IVDD can be indicated with adequate clinical response to dysfunction degrees ranging from I to III, either at rest or in restricted space and with a low rate of relapse.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de doença do disco intervertebral cervical (DDIV; C1-C5 ou C6-T2) submetidos ao tratamento clínico e avaliar a resposta a terapia instituída e o índice de recidiva. Esse estudo também visou demonstrar a idade, o gênero e a resposta ao tratamento de acordo com o grau neurológico, a fim de verificar se esses parâmetros podem ser utilizados como fatores prognósticos para a evolução clínica desses pacientes. Foram revisados os registros neurológicos do Hospital Veterinário Universitário de janeiro de 2006 a março de 2017. Realizaram coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Avaliaram 177 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 78 delas. As raças mais frequentes foram Dachshunds, seguido dos cães sem raça definida. Quanto ao grau de disfunção neurológica, 58,97% apresentavam grau I (somente dor), 25,64% estavam em grau II (tetraparesia ambulatória) e 15,38% em grau III (tetraparesia não ambulatória). O repouso absoluto e em espaço restrito foram realizados em 75,64% e 24,36% dos casos, respectivamente e com duração de no mínimo uma semana, podendo chegar a mais de quatro semanas. A maioria dos animais era de pequeno porte (≤15kg). A recuperação foi satisfatória em 87,17% dos cães e insatisfatória em 12,83%. Quanto à recidiva, esta foi observada em 10,3% dos pacientes com recuperação satisfatória. O tratamento clínico para cães com DDIV cervical pode ser indicado com adequada resposta clínica para graus de disfunção que variam de I a III, seja em repouso absoluto ou em espaço restrito e com baixo índice de recidiva.(AU)

Extrusão de disco intervertebral intradural em um cão / Intradural disc extrusion in a dog

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localizationof the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusionat a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intraduralintervertebral disc extrusion not preceded by a traumatic event.Case: A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysispreceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscletone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal onthe right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographsof the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourthlumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4.Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease wassuspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material.The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord andremoved. Subsequent histopathological...

Clinical management of dogs with presumptive diagnosis of cervical intervertebral disc disease: 78 cases (2006-2017)

ABSTRACT: This study aimed to identify dogs with a presumptive diagnosis of cervical intervertebral disc disease (IVDD; C1-C5 or C6-T2) submitted to clinical management and evaluate the outcome. This study also aimed to demonstrate the age, sex, and treatment response according to the neurological degree, and verify whether those factors could potentially influence the outcome. The data were obtained from patients with a neurological dysfunction, admitted at the Veterinary Hospital from January 2006 to March 2017. In addition to patient records, the tutors answered a questionnaire related to the success of therapy. A hundred and seventy-seven neurological records were evaluated, and 78 were included in the study according to the inclusion criteria. The most frequent breeds were Dachshunds, followed by mixed-breed dogs. Regarding the neurological dysfunction degree, 58.97% presented grade I (only neck pain), 25.64% were grade II (ambulatory tetraparesis), and 15.38% grade III (nonambulatory tetraparesis). Absolute and partial space rest were performed in 75.64% and 24.36% of the cases, respectively. The minimum rest time was one week and could come up to four weeks. Most dogs were small-sized (15kg). The recovery was satisfactory in 87.17% of dogs and unsatisfactory in 12.83%. Regarding recurrence, we observed that 10.3% of dogs presented satisfactory recovery. The clinical treatment for dogs with cervical IVDD can be indicated with adequate clinical response to dysfunction degrees ranging from I to III, either at rest or in restricted space and with a low rate of relapse.

RESUMO: O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de doença do disco intervertebral cervical (DDIV; C1-C5 ou C6-T2) submetidos ao tratamento clínico e avaliar a resposta a terapia instituída e o índice de recidiva. Esse estudo também visou demonstrar a idade, o gênero e a resposta ao tratamento de acordo com o grau neurológico, a fim de verificar se esses parâmetros podem ser utilizados como fatores prognósticos para a evolução clínica desses pacientes. Foram revisados os registros neurológicos do Hospital Veterinário Universitário de janeiro de 2006 a março de 2017. Realizaram coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Avaliaram 177 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 78 delas. As raças mais frequentes foram Dachshunds, seguido dos cães sem raça definida. Quanto ao grau de disfunção neurológica, 58,97% apresentavam grau I (somente dor), 25,64% estavam em grau II (tetraparesia ambulatória) e 15,38% em grau III (tetraparesia não ambulatória). O repouso absoluto e em espaço restrito foram realizados em 75,64% e 24,36% dos casos, respectivamente e com duração de no mínimo uma semana, podendo chegar a mais de quatro semanas. A maioria dos animais era de pequeno porte (15kg). A recuperação foi satisfatória em 87,17% dos cães e insatisfatória em 12,83%. Quanto à recidiva, esta foi observada em 10,3% dos pacientes com recuperação satisfatória. O tratamento clínico para cães com DDIV cervical pode ser indicado com adequada resposta clínica para graus de disfunção que variam de I a III, seja em repouso absoluto ou em espaço restrito e com baixo índice de recidiva.

Discopatia toracolombar canina: etiopatogenia, classificações atuais e opções terapêuticas / Canine thoracolumbar disc disease: pathogenesis, current classifications and therapeutic options / Discopatía toracolumbar en perros: etiopatogenia, clasificaciones actuales y opciones terapéuticas

A doença do disco intervertebral (DDIV) é uma das afecções neurológicas que mais afetam a região toracolombar no cão. Várias causas podem estar envolvidas na etiopatogenia da doença, mas considera-se que a origem dessa afecção difere entre raças condrodistróficas e não condrodistróficas; no entanto, alterações bioquímicas e moleculares são encontradas no disco degenerado, independentemente de diferenças raciais. Com a utilização de exames de imagem avançados, outros tipos de degeneração têm sido relatados, além dos já expostos por Hansen na década de 1960, e, em função desses novos achados, estão sendo realizadas associações de fármacos e outras formas de tratamentos para a DDIV, com o intuito de otimizar a recuperação dos cães acometidos. O objetivo desta revisão foi reunir informações acerca da doença do disco intervertebral toracolombar, tais como etiopatogenia, classificações atuais e opções de tratamento.

Intervertebral disc disease (IVDD) is a common disorder, and most frequently affects the spinal cord at thoracolumbar region. Multiple factors are involved in the pathogenesis of the disease, and it has different characteristics in chondrodystrophic and non-chondrodystrophic breeds. Biochemical and molecular changes observed in the degenerate disc are similar independent of the affected breed. Advanced image techniques demonstrate degenerative characteristics different than those reported by Hansen in the 1960s. Based on and in light of these new findings, new treatments for IVDD have been roosed to optimize the recovery of affected dogs. We reviewed the literature related to thoracolumbar intervertebral disc disease in dogs with emphasis on pathogenesis, classification and treatment options.

La enfermedad del disco intervertebral (EDIV) es una de las afecciones neurológicas que más afectan la región toracolumbar de los perros. Varias son las causas que pueden estar relacionadas con la etiopatogenia de la enfermedad, pero se considera que el origen de la misma difiere para los perros condrodistróficos, además de que se han encontrado alteraciones bioquímicas y moleculares en el disco degenerado, independientemente de la raza. Los exámenes de imagen avanzados han permitido la descripción de diferentes tipos de degeneraciones, además de las descriptas por Hansen en la década de 1960; en función de estas nuevas descripciones se ha sugerido la utilización de asociaciones de fármacos y otros tratamientos para la EDIV, con el objetivo de mejorar la recuperación de esos perros. El objetivo de esta revisión ha sido reunir informaciones sobre la EDIV toracolumbar relacionadas con su origen, las actuales propuestas de clasificación y sus opciones terapéuticas.

Discopatia toracolombar canina: etiopatogenia, classificações atuais e opções terapêuticas / Canine thoracolumbar disc disease: pathogenesis, current classifications and therapeutic options / Discopatía toracolumbar en perros: etiopatogenia, clasificaciones actuales y opciones terapéuticas

A doença do disco intervertebral (DDIV) é uma das afecções neurológicas que mais afetam a região toracolombar no cão. Várias causas podem estar envolvidas na etiopatogenia da doença, mas considera-se que a origem dessa afecção difere entre raças condrodistróficas e não condrodistróficas; no entanto, alterações bioquímicas e moleculares são encontradas no disco degenerado, independentemente de diferenças raciais. Com a utilização de exames de imagem avançados, outros tipos de degeneração têm sido relatados, além dos já expostos por Hansen na década de 1960, e, em função desses novos achados, estão sendo realizadas associações de fármacos e outras formas de tratamentos para a DDIV, com o intuito de otimizar a recuperação dos cães acometidos. O objetivo desta revisão foi reunir informações acerca da doença do disco intervertebral toracolombar, tais como etiopatogenia, classificações atuais e opções de tratamento.(AU)

Intervertebral disc disease (IVDD) is a common disorder, and most frequently affects the spinal cord at thoracolumbar region. Multiple factors are involved in the pathogenesis of the disease, and it has different characteristics in chondrodystrophic and non-chondrodystrophic breeds. Biochemical and molecular changes observed in the degenerate disc are similar independent of the affected breed. Advanced image techniques demonstrate degenerative characteristics different than those reported by Hansen in the 1960s. Based on and in light of these new findings, new treatments for IVDD have been roosed to optimize the recovery of affected dogs. We reviewed the literature related to thoracolumbar intervertebral disc disease in dogs with emphasis on pathogenesis, classification and treatment options.(AU)

La enfermedad del disco intervertebral (EDIV) es una de las afecciones neurológicas que más afectan la región toracolumbar de los perros. Varias son las causas que pueden estar relacionadas con la etiopatogenia de la enfermedad, pero se considera que el origen de la misma difiere para los perros condrodistróficos, además de que se han encontrado alteraciones bioquímicas y moleculares en el disco degenerado, independientemente de la raza. Los exámenes de imagen avanzados han permitido la descripción de diferentes tipos de degeneraciones, además de las descriptas por Hansen en la década de 1960; en función de estas nuevas descripciones se ha sugerido la utilización de asociaciones de fármacos y otros tratamientos para la EDIV, con el objetivo de mejorar la recuperación de esos perros. El objetivo de esta revisión ha sido reunir informaciones sobre la EDIV toracolumbar relacionadas con su origen, las actuales propuestas de clasificación y sus opciones terapéuticas.(AU)

Fisioterapia na recuperação funcional e qualidade de vida de cães paraplégicos por doença do disco intervertebral (Hansen tipo I) toracolombar submetidos à cirurgia descompressiva / Physiotherapy in functional recovery and quality of life of paraplegic dogs due to thoracolumbar intervertebral disc disease (Hansen type I) submitted to decompressive surgery

Este estudo retrospectivo incluiu cães paraplégicos com ausência de percepção a dor profunda secundário a doença do disco intervertebral toracolombar e submetidos à cirurgia descompressiva. Teve como objetivo comparar a recuperação funcional e a qualidade de vida (QV) quando submetidos a um protocolo em um centro especializado ou a domicílio realizado pelo tutor. Vinte e oito cães foram distribuídos no grupo A (GA) e submetidos ao protocolo domiciliar e 38 denominados grupo B (GB) em um centro especializado. Recuperaram a habilidade de caminhar 43% dos cães em uma média de 40 dias de pós-operatório (PO) no GA e 42% em uma média de 36 dias no GB. Em 53% dos casos (35/66) os cães permaneceram paraplégicos sem percepção a dor profunda ao final do período de 90 dias de PO. Vinte e cinco tutores do GA e 26 do GB responderam um questionário sobre a QV, com no mínimo seis meses de PO. A avaliação do tempo de sobrevida dos animais, realização de eutanásia e nota atribuída a QV demonstraram que os cães do GB provavelmente foram beneficiados pelo estreito acompanhamento e orientação aos tutores até 90 dias PO.(AU)

The retrospective study included paraplegic dogs affected by thoracolumbar intervertebral disc disease with absence of deep pain perception and submitted to a decompressive surgical technique. The aim was to compare functional recovery and quality of life (QOL) of dogs that underwent a home physiotherapy protocol to dogs that were cared in a specialized center. Twenty-eight dogs were placed in group A (GA, home physiotherapy protocol) and other 38 patients were placed in group B (GB, physiotherapy protocol in a specialized center). Forty three percent (43%) of the patients recovered the ability to walk in an average of 40 postoperative (PO) days in GA and 42% in an average of 36 days in GB. In 53% of the cases (35/66) the dogs remained paraplegic without deep pain perception at the end of physiotherapeutic protocols. Twenty-five owners from GA and 26 from GB answered a questionnaire about QOL, with a minimum of six PO months. The evaluation of the animals survival time, euthanasia and the QOL score demonstrated that dogs that underwent a physiotherapeutic treatment in a specialized center probably were benefited by the close monitoring and orientation to owners until 90 days of PO.(AU)

Fisioterapia na recuperação funcional e qualidade de vida de cães paraplégicos por doença do disco intervertebral (Hansen tipo I) toracolombar submetidos à cirurgia descompressiva / Physiotherapy in functional recovery and quality of life of paraplegic dogs due to thoracolumbar intervertebral disc disease (Hansen type I) submitted to decompressive surgery

Este estudo retrospectivo incluiu cães paraplégicos com ausência de percepção a dor profunda secundário a doença do disco intervertebral toracolombar e submetidos à cirurgia descompressiva. Teve como objetivo comparar a recuperação funcional e a qualidade de vida (QV) quando submetidos a um protocolo em um centro especializado ou a domicílio realizado pelo tutor. Vinte e oito cães foram distribuídos no grupo A (GA) e submetidos ao protocolo domiciliar e 38 denominados grupo B (GB) em um centro especializado. Recuperaram a habilidade de caminhar 43% dos cães em uma média de 40 dias de pós-operatório (PO) no GA e 42% em uma média de 36 dias no GB. Em 53% dos casos (35/66) os cães permaneceram paraplégicos sem percepção a dor profunda ao final do período de 90 dias de PO. Vinte e cinco tutores do GA e 26 do GB responderam um questionário sobre a QV, com no mínimo seis meses de PO. A avaliação do tempo de sobrevida dos animais, realização de eutanásia e nota atribuída a QV demonstraram que os cães do GB provavelmente foram beneficiados pelo estreito acompanhamento e orientação aos tutores até 90 dias PO.(AU)

The retrospective study included paraplegic dogs affected by thoracolumbar intervertebral disc disease with absence of deep pain perception and submitted to a decompressive surgical technique. The aim was to compare functional recovery and quality of life (QOL) of dogs that underwent a home physiotherapy protocol to dogs that were cared in a specialized center. Twenty-eight dogs were placed in group A (GA, home physiotherapy protocol) and other 38 patients were placed in group B (GB, physiotherapy protocol in a specialized center). Forty three percent (43%) of the patients recovered the ability to walk in an average of 40 postoperative (PO) days in GA and 42% in an average of 36 days in GB. In 53% of the cases (35/66) the dogs remained paraplegic without deep pain perception at the end of physiotherapeutic protocols. Twenty-five owners from GA and 26 from GB answered a questionnaire about QOL, with a minimum of six PO months. The evaluation of the animals survival time, euthanasia and the QOL score demonstrated that dogs that underwent a physiotherapeutic treatment in a specialized center probably were benefited by the close monitoring and orientation to owners until 90 days of PO.(AU)

Evaluation of the influence of kyphosis and scoliosis on intervertebral disc extrusion in French bulldogs.

BACKGROUND: Although thoracic vertebral malformations with kyphosis and scoliosis are often considered incidental findings on diagnostic imaging studies of screw-tailed brachycephalic breeds, they have been suggested to interfere with spinal biomechanics and intervertebral disc degeneration. It is however unknown if an abnormal spinal curvature also predisposes dogs to develop clinically relevant intervertebral disc herniations. The aim of this study was to evaluate if the occurrence of thoracic vertebral malformations, kyphosis or scoliosis would be associated with a higher prevalence of cervical or thoracolumbar intervertebral disc extrusion in French bulldogs. RESULTS: French bulldogs that underwent computed tomography for reasons unrelated to spinal disease (n = 101), and French bulldogs with thoracolumbar (n = 47) or cervical intervertebral disc extrusion (n = 30) that underwent magnetic resonance imaging were included. There was a significant association between the presence of kyphosis and the occurrence of intervertebral disc extrusion, particularly in the thoracolumbar region. Dogs with kyphosis were at nearly a two times increased odds of being affected by intervertebral disc extrusion than those without kyphosis [(OR = 1.98 (95% CI: 1.04-3.78)]. There was also an association between the presence of scoliosis and the anatomical distribution of intervertebral disc extrusions, with dogs with scoliosis more likely to have more caudal lumbar intervertebral disc extrusions. Presence of scoliosis was not associated with an increased odds of being affected by intervertebral disc extrusion. CONCLUSIONS: Although thoracic vertebral malformations with kyphosis only rarely cause spinal cord dysfunction in itself, French bulldogs with kyphosis appear to be at higher risk to develop thoracolumbar intervertebral disc extrusion.

Hérnia de disco tipo III em um cão / Type III disc herniation in a dog

Background: Acute and non-compressive nucleus pulposus extrusion, also called type III disc herniation, usually results from extreme exercises or traumatic episodes and is characterized by an acute extrusion without a compression of the spinal cord. Extrusion reaches the spinal cord at high speed, causing bruising in its parenchyma, and dissipates through the epidural space without causing compression. This report aims to describe the clinical signs, diagnosis and treatment of a canine patient possibly affected by acute non-compressive extrusion of the intervertebral disc, as well as the evolution of the case with the proposed therapy.Case: A 7-year-old male Dachshund, weighing 9.4 kg, was presented with an acute loss of hind limb locomotion. At the neurological examination, paraplegia of acute onset with absence of deep pain, increased muscle tone, and increased patellar and withdrawal reflexes in hind limbs was found, as well as pain on epaxial palpation of the thoracolumbar spine. The perineal reflex was preserved, and the cutaneous trunci reflex was absent until the level of the second lumbar vertebra (L2). Magnetic resonance imaging (MRI) showed an uncompressed heterogeneous hyper intense area in the thoracolumbar spinal cord on the intervertebral disc (IVD) between T13-L1. Based on the imaging findings, a presumptive diagnosis of an acute non-compressive disc extrusion was assumed, thus discarding the need for surgical decompression. The patient was hospitalized, initially being treated with dexamethasone, tramadol and dipyrone. After 24 hours of hospitalization, the dog recovered deep pain in the pelvic limbs and control over urination. The dog was then discharged from hospital and was prescribed prednisolone and absolute rest. After 25 days of clinical onset, there was a significant improvement in the patient neurological status, presenting only an ataxia of the pelvic limbs.[...](AU)

Hérnia de disco tipo III em um cão / Type III disc herniation in a dog

Background: Acute and non-compressive nucleus pulposus extrusion, also called type III disc herniation, usually results from extreme exercises or traumatic episodes and is characterized by an acute extrusion without a compression of the spinal cord. Extrusion reaches the spinal cord at high speed, causing bruising in its parenchyma, and dissipates through the epidural space without causing compression. This report aims to describe the clinical signs, diagnosis and treatment of a canine patient possibly affected by acute non-compressive extrusion of the intervertebral disc, as well as the evolution of the case with the proposed therapy.Case: A 7-year-old male Dachshund, weighing 9.4 kg, was presented with an acute loss of hind limb locomotion. At the neurological examination, paraplegia of acute onset with absence of deep pain, increased muscle tone, and increased patellar and withdrawal reflexes in hind limbs was found, as well as pain on epaxial palpation of the thoracolumbar spine. The perineal reflex was preserved, and the cutaneous trunci reflex was absent until the level of the second lumbar vertebra (L2). Magnetic resonance imaging (MRI) showed an uncompressed heterogeneous hyper intense area in the thoracolumbar spinal cord on the intervertebral disc (IVD) between T13-L1. Based on the imaging findings, a presumptive diagnosis of an acute non-compressive disc extrusion was assumed, thus discarding the need for surgical decompression. The patient was hospitalized, initially being treated with dexamethasone, tramadol and dipyrone. After 24 hours of hospitalization, the dog recovered deep pain in the pelvic limbs and control over urination. The dog was then discharged from hospital and was prescribed prednisolone and absolute rest. After 25 days of clinical onset, there was a significant improvement in the patient neurological status, presenting only an ataxia of the pelvic limbs.[...]

Avaliação clínica de cães com doença do disco intervertebral (Hansen tipo I) submetidos à descompressão cirúrgica: 110 casos / Clinical evaluation of dogs with intervertebral disc disease (Hansen type I) submitted to surgical decompression: 110 cases

O objetivo deste estudo foi identificar cães com doença do disco intervertebral toracolombar (Hansen tipo I) submetidos ao tratamento cirúrgico em um serviço de rotina em neurologia de um hospital veterinário universitário no período de 2006 a 2014, e obter informações a respeito da idade, do sexo, da raça, local da extrusão, interpretação da mielografia, avaliação dos graus de disfunção neurológica, recuperação funcional desses cães e observar a ocorrência de recidiva dos sinais clínicos da doença. A raça mais frequente foi Dachshund (69%), seguida dos cães sem raça definida (14,5%). Os locais mais afetados foram entre T12-T13 (31,9%) e L1-L2 (19,1%). Dos 110 cães, 74 (67,3%) tiveram melhora dos sinais clínicos após o procedimento cirúrgico, sendo 54 (49,1%) considerados satisfatórios e 20 (18,2%), parcialmente satisfatórios. Destes cães, seis (8,1%) cães estavam em grau II, 19 (25,7%) em grau III, 35 (47,3%) em grau IV e 14 (18,9%) em grau V. Pode-se concluir que o tratamento cirúrgico promove recuperação funcional satisfatória na maioria dos cães com extrusão de disco toracolombar. O prognóstico para recuperação funcional após o tratamento cirúrgico é tanto melhor quanto menor for o grau de disfunção neurológica e o percentual de recidiva é baixo em animais submetidos a este tipo de terapia.(AU)

The aim of this study was to identify dogs with thoracolumbar intervertebral disc disease (Hansen type I) submitted for surgical treatment on a routine service in neurology in a university veterinary hospital in 2006-2014, and to get information about age, sex, breed, site of extrusion, interpretation of myelography, evaluation of the degree of neurological dysfunction, functional recovery of these dogs, and to verify the recurrence of clinical signs of disease. The most common breed was Dachshund (69%), followed by mixed breed (14.5%). The most affected sites were between T12-T13 (31.9%) and L1-L2 (19.1%). Of the 110 dogs, 74 (67.3%) improved clinical signs after surgery, 54 (49.1%) satisfactory and 20 (18.2%), in part satisfactory. From these dogs, six (8.1%) dogs were in grade II, 19 (25.7%) in grade III, 35 (47.3%) in grade IV, and 14 (18.9%) in grade V. It can be concluded that satisfactory surgical treatment promotes functional recovery in most dogs with thoracolumbar disk extrusion. The prognosis for functional recovery after surgical treatment is better the lower the degree of neurological dysfunction and the recurrence percentage is lower in dogs subjected to this type of therapy.(AU)

Avaliação clínica de cães com doença do disco intervertebral (Hansen tipo I) submetidos à descompressão cirúrgica: 110 casos / Clinical evaluation of dogs with intervertebral disc disease (Hansen type I) submitted to surgical decompression: 110 cases

O objetivo deste estudo foi identificar cães com doença do disco intervertebral toracolombar (Hansen tipo I) submetidos ao tratamento cirúrgico em um serviço de rotina em neurologia de um hospital veterinário universitário no período de 2006 a 2014, e obter informações a respeito da idade, do sexo, da raça, local da extrusão, interpretação da mielografia, avaliação dos graus de disfunção neurológica, recuperação funcional desses cães e observar a ocorrência de recidiva dos sinais clínicos da doença. A raça mais frequente foi Dachshund (69%), seguida dos cães sem raça definida (14,5%). Os locais mais afetados foram entre T12-T13 (31,9%) e L1-L2 (19,1%). Dos 110 cães, 74 (67,3%) tiveram melhora dos sinais clínicos após o procedimento cirúrgico, sendo 54 (49,1%) considerados satisfatórios e 20 (18,2%), parcialmente satisfatórios. Destes cães, seis (8,1%) cães estavam em grau II, 19 (25,7%) em grau III, 35 (47,3%) em grau IV e 14 (18,9%) em grau V. Pode-se concluir que o tratamento cirúrgico promove recuperação funcional satisfatória na maioria dos cães com extrusão de disco toracolombar. O prognóstico para recuperação funcional após o tratamento cirúrgico é tanto melhor quanto menor for o grau de disfunção neurológica e o percentual de recidiva é baixo em animais submetidos a este tipo de terapia.(AU)

The aim of this study was to identify dogs with thoracolumbar intervertebral disc disease (Hansen type I) submitted for surgical treatment on a routine service in neurology in a university veterinary hospital in 2006-2014, and to get information about age, sex, breed, site of extrusion, interpretation of myelography, evaluation of the degree of neurological dysfunction, functional recovery of these dogs, and to verify the recurrence of clinical signs of disease. The most common breed was Dachshund (69%), followed by mixed breed (14.5%). The most affected sites were between T12-T13 (31.9%) and L1-L2 (19.1%). Of the 110 dogs, 74 (67.3%) improved clinical signs after surgery, 54 (49.1%) satisfactory and 20 (18.2%), in part satisfactory. From these dogs, six (8.1%) dogs were in grade II, 19 (25.7%) in grade III, 35 (47.3%) in grade IV, and 14 (18.9%) in grade V. It can be concluded that satisfactory surgical treatment promotes functional recovery in most dogs with thoracolumbar disk extrusion. The prognosis for functional recovery after surgical treatment is better the lower the degree of neurological dysfunction and the recurrence percentage is lower in dogs subjected to this type of therapy.(AU)

Análise do impacto da acupuntura no tratamento da doença do disco intervertebral toracolombar em cães / Analysis of the acupuncture impact in treating thoracolumbar intervertebral disc disease in dogs / Análisis del impacto de la acupuntura en el tratamiento de la enfermedad del disco intervertebral toracolumbar en pertos

A região toracolombar é o local onde ocorre a maior incidência de doença do disco intervertebral (DDIV), que é o distúrbio neurológico cirúrgico mais diagnosticado em pacientes veterinários. O tratamento pode ser conservador ou cirúrgico. Neste trabalho foi feito um estudo retrospectivo e acompanhamento de 23 casos de DDIV toracolombar, atendidos por uma veterinária acupunturista e uma veterinária neurocirurgiã, ambas atuantes na região de Campinas entre os anos de 2012 e 2014. Os pacientes foram graduados de acordo com a sintomatologia apresentada. Em seguida, foi feito um levantamento em função do tratamento realizado, efetuando-se uma nova graduação do estado do animal. Após estudo comparativo, a acupuntura comprovou ser uma importante ferramenta para a reabilitação de cães com paralisia e perda de nocicepção profunda. Entre os animais com presença de nocicepção profunda que não estavam paralisados, a acupuntura reabilitou todos os casos que apresentavam apenas lombalgia ou paraparesia deambulatória. Entre aqueles paralisados com presença de nocicepção profunda, a taxa de reabilitação entre os pacientes submetidos a acupuntura ou cirurgia isoladamente foi idêntica (75%), ficando apenas abaixo de tal taxa quando as duas técnicas foram associadas (100%).

The thoracolumbar region places the highest incidence of the intervertebral discdiease, which is the most diagnosed surgical neurological disorder in veterinary patients. Treatment can be conservative or surgical. In this paper a retrospective study and follow-up of 23 cases ofthoracolumbar intervertebral discdisease, attended by a acupuncturist veterinary and a neurosurgeon veterinary, both active in the region of Campinas between the years 2012 and 2014. lhe patients were graded according to the symptoms. Then a survey was done on the basis of treatment carried out, making up a new graduation of the animal state. After comparative study, acupuncture proved to be an important tool for dogs rehabilitation with paralysis and loss of deep nociception. Among the animais with the presence of deep nociception that were not paralyzed, acupuncture rehabilitated ali cases with only low back pain or paraparesis ambulation. Among those paralyzed with presence of deep nociception, rehabilitation rate among patients undergoing acupuncture or surgery alone was identical (75%), and just below that rate when the two techniques were associated (100%).

La región toracolumbar es donde hay la mayor incidencia de la enfermedad del disco intervertebral, que es el trastorno neurológicoquirúrgico más diagnosticado en pacientes veterinarios. El tratamiento puede ser conservador o quirúrgico. En este trabajo un estudio retrospectivo y el seguimiento de 23 casos de la enfermedad del disco intervertebral toracolumbar, asistido por una veterinaria acupunturista y una veterinaria neurocirujana, ambas activas en la región de Campinas entre los anos 2012 y 2014. Los pacientes fueron clasificados de acuerdo los síntomas presentados. A continuación, se realizó una encuesta sobre la base del tratamiento llevado a cabo, 10 que representó un nuevo graduado del estado animal. Después de un estudio comparativo, la acupuntura ha demostrado ser una herramienta importante para la rehabilitación de perros paralizados y con pierda de la nocicepción profunda. Entre los animales con la presencia de la nocicepción profunda que no se paralizó, la acupuntura ha rehabilitado todos los casos con dolor de espalda baja o paraparesia con deambulación. Entre los animales paralisados con presencia de la nocicepción profunda, la tasa de rehabilitación de los pacientes sometidos a acupuntura o la cirugía sola fue idéntico (75%), y justo debajo de esa tasa cuando se asociaron las dos técnicas (100%).

Análise do impacto da acupuntura no tratamento da doença do disco intervertebral toracolombar em cães / Analysis of the acupuncture impact in treating thoracolumbar intervertebral disc disease in dogs / Análisis del impacto de la acupuntura en el tratamiento de la enfermedad del disco intervertebral toracolumbar en pertos

A região toracolombar é o local onde ocorre a maior incidência de doença do disco intervertebral (DDIV), que é o distúrbio neurológico cirúrgico mais diagnosticado em pacientes veterinários. O tratamento pode ser conservador ou cirúrgico. Neste trabalho foi feito um estudo retrospectivo e acompanhamento de 23 casos de DDIV toracolombar, atendidos por uma veterinária acupunturista e uma veterinária neurocirurgiã, ambas atuantes na região de Campinas entre os anos de 2012 e 2014. Os pacientes foram graduados de acordo com a sintomatologia apresentada. Em seguida, foi feito um levantamento em função do tratamento realizado, efetuando-se uma nova graduação do estado do animal. Após estudo comparativo, a acupuntura comprovou ser uma importante ferramenta para a reabilitação de cães com paralisia e perda de nocicepção profunda. Entre os animais com presença de nocicepção profunda que não estavam paralisados, a acupuntura reabilitou todos os casos que apresentavam apenas lombalgia ou paraparesia deambulatória. Entre aqueles paralisados com presença de nocicepção profunda, a taxa de reabilitação entre os pacientes submetidos a acupuntura ou cirurgia isoladamente foi idêntica (75%), ficando apenas abaixo de tal taxa quando as duas técnicas foram associadas (100%).(AU)

The thoracolumbar region places the highest incidence of the intervertebral discdiease, which is the most diagnosed surgical neurological disorder in veterinary patients. Treatment can be conservative or surgical. In this paper a retrospective study and follow-up of 23 cases ofthoracolumbar intervertebral discdisease, attended by a acupuncturist veterinary and a neurosurgeon veterinary, both active in the region of Campinas between the years 2012 and 2014. lhe patients were graded according to the symptoms. Then a survey was done on the basis of treatment carried out, making up a new graduation of the animal state. After comparative study, acupuncture proved to be an important tool for dogs rehabilitation with paralysis and loss of deep nociception. Among the animais with the presence of deep nociception that were not paralyzed, acupuncture rehabilitated ali cases with only low back pain or paraparesis ambulation. Among those paralyzed with presence of deep nociception, rehabilitation rate among patients undergoing acupuncture or surgery alone was identical (75%), and just below that rate when the two techniques were associated (100%).(AU)

La región toracolumbar es donde hay la mayor incidencia de la enfermedad del disco intervertebral, que es el trastorno neurológicoquirúrgico más diagnosticado en pacientes veterinarios. El tratamiento puede ser conservador o quirúrgico. En este trabajo un estudio retrospectivo y el seguimiento de 23 casos de la enfermedad del disco intervertebral toracolumbar, asistido por una veterinaria acupunturista y una veterinaria neurocirujana, ambas activas en la región de Campinas entre los anos 2012 y 2014. Los pacientes fueron clasificados de acuerdo los síntomas presentados. A continuación, se realizó una encuesta sobre la base del tratamiento llevado a cabo, 10 que representó un nuevo graduado del estado animal. Después de un estudio comparativo, la acupuntura ha demostrado ser una herramienta importante para la rehabilitación de perros paralizados y con pierda de la nocicepción profunda. Entre los animales con la presencia de la nocicepción profunda que no se paralizó, la acupuntura ha rehabilitado todos los casos con dolor de espalda baja o paraparesia con deambulación. Entre los animales paralisados con presencia de la nocicepción profunda, la tasa de rehabilitación de los pacientes sometidos a acupuntura o la cirugía sola fue idéntico (75%), y justo debajo de esa tasa cuando se asociaron las dos técnicas (100%).(AU)