Clinical management of dogs with presumptive diagnosis of thoracolumbar intervertebral disc disease: 164 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral toracolombar: 164 casos (2006-2017)

This study aimed to identify dogs with presumptive diagnosis of cervical intervertebral disc disease (IVDD) submitted to clinical management and to evaluate the outcomes. Data were obtained from the medical records of patients with neurological dysfunction assisted at a University Veterinary Hospital from 2006 to 2017. In addition to the patients' records, dog owners responded to a questionnaire on the success of therapy. Four hundred and thirteen neurological records were evaluated, and 164 met the inclusion criteria of the study. The most common breed was Dachshund, followed by mongrels. Classification of neurological dysfunction in the study sample was as follows: 15.9% with grade I, 25.6% with grade II, 26.8% with grade III, 8.5% with grade IV, and 23.2% with grade V. Outcome was satisfactory in 71.6% of the dogs and unsatisfactory in 28.4% of them. Recurrence was observed in 27.7% of those with satisfactory outcomes. The clinical treatment of dogs with thoracolumbar IVDD is satisfactory, particularly for animals with milder disease grades (I, II, and III). There is possibility of recurrence with conservative therapy and clinical signs may be more severe.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de DDIV toracolombar submetidos ao tratamento clínico, a fim de avaliar a resposta à terapia instituída. Foram revisados os registros neurológicos de cães atendidos pelo Serviço de Neurologia e Neurocirurgia Veterinária no período de 2006 a 2017 de um Hospital Veterinário Universitário. Foi realizada coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Foram avaliadas 413 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 164 delas. As raças mais frequentes foram dachshunds, seguido de cães sem raça definida. Quanto ao grau de disfunção neurológica foi definido como grau I para 15,9% dos cães, grau II para 25,6%, grau III para 26,8%, grau IV para 8,5% e grau V para 23,2%. A recuperação foi satisfatória em 71,6% dos cães e insatisfatória em 28,4%. Dos que se recuperaram satisfatoriamente, 27,7% tiveram recidivas. Com base nos resultados obtidos pode-se concluir que o tratamento clínico em repouso absoluto e administração de anti-inflamatórios e analgésicos opióides para cães com DDIV toracolombar é efetivo, principalmente para cães em graus mais leves da doença (grau I, II e III). Há possibilidade de recidiva com esse tipo de terapia cujos sinais clínicos poderão ser mais graves.(AU)

Clinical management of dogs with presumptive diagnosis of thoracolumbar intervertebral disc disease: 164 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral toracolombar: 164 casos (2006-2017)

This study aimed to identify dogs with presumptive diagnosis of cervical intervertebral disc disease (IVDD) submitted to clinical management and to evaluate the outcomes. Data were obtained from the medical records of patients with neurological dysfunction assisted at a University Veterinary Hospital from 2006 to 2017. In addition to the patients' records, dog owners responded to a questionnaire on the success of therapy. Four hundred and thirteen neurological records were evaluated, and 164 met the inclusion criteria of the study. The most common breed was Dachshund, followed by mongrels. Classification of neurological dysfunction in the study sample was as follows: 15.9% with grade I, 25.6% with grade II, 26.8% with grade III, 8.5% with grade IV, and 23.2% with grade V. Outcome was satisfactory in 71.6% of the dogs and unsatisfactory in 28.4% of them. Recurrence was observed in 27.7% of those with satisfactory outcomes. The clinical treatment of dogs with thoracolumbar IVDD is satisfactory, particularly for animals with milder disease grades (I, II, and III). There is possibility of recurrence with conservative therapy and clinical signs may be more severe.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de DDIV toracolombar submetidos ao tratamento clínico, a fim de avaliar a resposta à terapia instituída. Foram revisados os registros neurológicos de cães atendidos pelo Serviço de Neurologia e Neurocirurgia Veterinária no período de 2006 a 2017 de um Hospital Veterinário Universitário. Foi realizada coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Foram avaliadas 413 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 164 delas. As raças mais frequentes foram dachshunds, seguido de cães sem raça definida. Quanto ao grau de disfunção neurológica foi definido como grau I para 15,9% dos cães, grau II para 25,6%, grau III para 26,8%, grau IV para 8,5% e grau V para 23,2%. A recuperação foi satisfatória em 71,6% dos cães e insatisfatória em 28,4%. Dos que se recuperaram satisfatoriamente, 27,7% tiveram recidivas. Com base nos resultados obtidos pode-se concluir que o tratamento clínico em repouso absoluto e administração de anti-inflamatórios e analgésicos opióides para cães com DDIV toracolombar é efetivo, principalmente para cães em graus mais leves da doença (grau I, II e III). Há possibilidade de recidiva com esse tipo de terapia cujos sinais clínicos poderão ser mais graves.(AU)

Ozonoterapia paravertebral en la patología de la columna vertebral lumbar / Terapia ozônio paravertebral na patologia da coluna lombar / Paravertebral ozone therapy in the pathology of the lumbar spine

Introducción: la búsqueda de alternativas terapéuticas para la atención al paciente con patología de la columna vertebral es una exigencia social, para lo cual se promueve el uso de la ozonoterapia. Objetivo: caracterizar la respuesta clínica de los pacientes con patología de la columna vertebral tratados con ozonoterapia paravertebral en el Hospital General Docente Dr Agostinho Neto de Guantánamo durante el período comprendido entre los meses de septiembre de 2017 y agosto de 2018. Método: se realizó un estudio observacional, prospectivo y transversal en el servicio de Neurocirugía en 78 pacientes con enfermedades de la columna vertebral, seleccionados intencionalmente y que participaron conscientemente en un preexperimento que consistió en la aplicación de un ciclo de diez sesiones de ozonoterapia por vía paravertebral durante un periodo de dos semanas. Se controlaron las siguientes variables: intensidad del dolor lumbar medida mediante la escala de evaluación analógica; incapacidad funcional evaluada mediante la escala de Oswestry. Resultados. la mayoría de los pacientes transitó a una categoría de dolor inferior y el 80,7 % se evaluó en la categoría leve­moderado después de la ozonoterapia. Esta posibilitó que en el mayor porcentaje disminuyera el grado de incapacidad funcional y la proporción con un grado mínimo de incapacidad función se incrementara en un 46,0 %. Conclusiones: la ozonoterapia paravertebral constituye una alternativa que puede ayudar en el tratamiento conservador del paciente con patología vertebral(AU)

Introduction: the search for therapeutic alternatives for patient care with pathology of the spine is a social requirement, for which the use of ozone therapy is promoted. Objective: to characterize the clinical response of patients with spinal pathologies treated with paravertebral ozone therapy at the Dr Agostinho Neto Guantanamo General Teaching Hospital during the period between September 2017 and August 2018. Method: a observational, prospective and cross-sectional study in the Neurosurgery service in 78 patients with diseases of the spine, intentionally selected and consciously involved in a preexperiment that consisted in the application of a cycle of ten sessions of ozone therapy by paravertebral route, during a period two weeks The following variables were controlled: lumbar pain intensity measured by the analogical evaluation scale; functional disability assessed by the Oswestry scale. Results: the majority of patients went to a lower pain category and 80.7% were evaluated in the mild-moderate category after ozone therapy. This made it possible for the highest percentage to decrease the degree of functional disability and the proportion with a minimum degree of disability function increased by 46.0%. Conclusions: Paravertebral ozone therapy is an alternative that can help in the conservative treatment of patients with vertebral pathology(AU)

Introdução: a busca de alternativas terapêuticas para o cuidado do paciente com patologia da coluna vertebral é uma exigência social, para a qual o uso da ozonioterapia é promovido. Objectivo: para caracterizar a resposta clínica de pacientes com patologia vertebral tratados com terapia de ozono paravertebral no Agostinho Neto Geral Teaching Hospital Dr Guantánamo durante o período de setembro 2017 a Agosto de 2018. Método: foi realizado um estudo de observação, em perspectiva e em corte transversal, no departamento de neurocirurgia em 78 pacientes com doenças da coluna vertebral, seleccionados intencionalmente e conscientemente participaram num preexperimento que consistia na aplicação de um ciclo de dez sessões de terapia de ozono através paravertebral, ao longo de um período duas semanas As seguintes variáveis foram controladas: intensidade da dor lombar medida pela escala de avaliação analógica; incapacidade funcional avaliada pela escala de Oswestry. Resultados: a maioria dos pacientes foi para uma categoria de dor mais baixa e 80,7% foram avaliados na categoria leve-moderada após a terapia com ozônio. Isso permitiu que o maior percentual diminuísse o grau de incapacidade funcional e a proporção com um grau mínimo de incapacidade aumentasse 46,0%. Conclusões: A terapia com ozônio paravertebral é uma alternativa que pode ajudar no tratamento conservador de pacientes com patologia vertebral(AU)

Case report of vancomycin-induced pancytopenia.

Vancomycin is the first-line agent for the treatment of bacteremia, endocarditis, pneumonia, cellulitis, and osteomyelitis. Pancytopenia is an uncommon adverse effect of vancomycin therapy, with only a few cases of vancomycin-related neutropenia and pancytopenia described in the literature. We describe a case of a 56-year-old man who was diagnosed with chronic paraspinal abscess and started on intravenous vancomycin. He was re-admitted two weeks later with new-onset pancytopenia. Discontinuation of vancomycin resulted in improved cell counts. Physicians should monitor cell counts in patients who are on long-term intravenous vancomycin.

Case report of vancomycin-induced pancytopenia

Abstract: Vancomycin is the first-line agent for the treatment of bacteremia, endocarditis, pneumonia, cellulitis, and osteomyelitis. Pancytopenia is an uncommon adverse effect of vancomycin therapy, with only a few cases of vancomycin-related neutropenia and pancytopenia described in the literature. We describe a case of a 56-year-old man who was diagnosed with chronic paraspinal abscess and started on intravenous vancomycin. He was re-admitted two weeks later with new-onset pancytopenia. Discontinuation of vancomycin resulted in improved cell counts. Physicians should monitor cell counts in patients who are on long-term intravenous vancomycin.

Does Pathogen Identification Influence the Clinical Outcomes in Patients With Pyogenic Spinal Infections?

STUDY DESIGN: Retrospective study. OBJECTIVE: To study the clinical outcomes of patients suffering from pyogenic spinal infections (PSI), by comparing the outcomes of patients with an identified microbiological agent with those of patients without an identified pathogen. SUMMARY OF BACKGROUND DATA: PSI is associated with significant risks for morbidity and mortality. Specific antibiotic treatment has been considered a key to successful medical treatment; however, clinicians frequently treat patients with PSI without an identified agent. A paucity of data is available comparing the clinical outcomes of patients with or without an identified pathogen. MATERIALS AND METHODS: The records of 97 consecutive patients discharged from a University Hospital with the diagnosis of PSI during a 14-year period were retrospectively reviewed. Patients' demographics, etiological agent, comorbidities, site of infection, white blood cell count, erythrocyte sedimentation rate, C-reactive protein at the time of presentation, neurological impairment, length of hospital stay, and mortality were registered to compare the clinical outcomes of patients with an identified pathogen with those of patients without an identified agent. RESULTS: The causative organism was identified in 74 patients (76.3%). Patients with microbiological diagnosis were younger, and a larger percentage of them exhibited elevated C-reactive protein value; however, they were not different from those without an identified agent in terms of sex, site of infection, comorbidities, and the presence of a concomitant infection. Our study could not demonstrate different neurological outcomes, length of stay, or mortality rates among the 2 groups. CONCLUSIONS: In a large series of patients with PSI, we did not demonstrate differences in clinical outcomes using empirical antibiotics in patients without an identified pathogen compared with patients with an identified microbiological agent receiving specific antibiotics. Future prospective multicenter studies should be conducted to obtain an answer to this important clinical question.

Discitis hematógena aguda en un adulto / Acute hematogenous discitis in an adult patient

Introducción: la discitis es una de las formas de presentación de los procesos infecciosos en el raquis. La de origen hematógeno es más frecuente en los niños y de modo raro aparece en el adulto asociada a una inmunodepresión, porque en esta edad ocurre generalmente como complicación de un proceder quirúrgico sobre el disco intervertebral. Objetivo: establecer las características clínicas e imaginológicas y el tratamiento de esta afección en el adulto. Descripción: se presentó un paciente masculino de 35 años de edad con antecedentes de salud anterior, que comenzó a presentar dolor en columna lumbar e impotencia funcional absoluta. Se realizaron estudios de laboratorio y de imágenes. Los parámetros hematológicos inclinaban al diagnóstico de un proceso infeccioso y la resonancia magnética nuclear evidenció una discitis. El tratamiento consistió en la administración de antibióticos e inmovilización. Conclusiones: el paciente presentó mejoría de los síntomas a las 72 h, con alivio total del dolor a las 2 semanas. Los resultados hematológicos mejoraron paulatinamente hasta alcanzar la normalidad a los 3 meses. Los estudios de imágenes fueron normales a los 6 meses y el paciente se incorporó a sus actividades habituales. la discitis hematógena en el adulto, aunque infrecuente, debe ser sospechada en todo paciente con síntomas dolorosos del raquis de posible origen infeccioso, que no responde a tratamiento médico y mucho más si concomita con algún grado de inmunodepresión(AU)

Introduction: Discitis is one of the forms of presentation of infectious processes of the spine. Discitis of hematogenous origin is more common in children. In adults it is a rare condition associated to immunosuppression, since it generally occurs as a complication of intervertebral disk surgery. Objective: Determine the clinical and imaging characteristics as well as the treatment of this condition in adults. Description: A male 35-year-old patient with a disease history presents with lumbar pain and total functional impotence. Laboratory and imaging studies were conducted. Hematological parameters pointed to an infectious process, and nuclear magnetic resonance imaging revealed a discitis. Treatment consisted of antibiotics and immobilization. Conclusions: The patient showed symptom improvement at 72 hours, with total pain relief at 2 weeks. There was gradual improvement in hematological results, which reached normal levels at 3 months. Imaging studies were normal at 6 months, and the patient resumed his daily routine. Adult hematogenous discitis, though infrequent, should be suspected in any patient with spinal pain symptoms of possible infectious origin not responding to clinical treatment, particularly when it is concomitant with some degree of immunosuppression(AU)

Chronic recurrent multifocal osteomyelitis primarily affecting the spine treated with anti-TNF therapy.

STUDY DESIGN: A case report describing chronic recurrent multifocal osteomyelitis (CRMO) with initial presentation limited to spine, successfully treated by anti-TNF-alpha therapy after failure of conventional treatment methods. OBJECTIVE: To describe an unusual manifestation and treatment of a rare disease. SUMMARY OF BACKGROUND DATA: CRMO is a rare inflammatory bone disease that should be differentiated from bacterial osteomyelitis. Rarely, it can affect the spine and in this case the most important differential diagnosis is infectious spondylodiscitis. The disease has an unpredictable course with exacerbations and spontaneous remissions. Although the majority of cases remit spontaneously (or after the use of nonsteroidal anti-inflammatory drugs [NSAIDs]), some progressive and resistant cases have been reported. METHODS: We describe a case of CRMO with an unusual clinical presentation emphasizing the importance of this finding as a differential diagnosis of spondylodiscitis and comment on the available treatment alternatives. RESULTS: A 17-year-old man presented with debilitating dorsal spine pain. Magnetic resonance imaging of the spine revealed bone lesions at multiple vertebral levels. After failure of antibiotic treatment, the diagnosis of CRMO was suggested. An initial good response to NSAIDs was followed by a recurrent course and involvement of peripheral joints besides the use of corticosteroids and other drugs. The introduction of infliximab was followed by complete remission of the disease. CONCLUSION: Our observation highlights the need of awareness for the differential diagnosis in suspected cases of osteomyelitis not responding to antibiotics. Anti-TNF-alpha agents should be considered in CRMO refractory cases.

Electro-acupuncture and Chinese herbs for treatment of cervical intervertebral disk disease in a dog.

A non-ambulatory dog with tetraparesis following a pain episode that had evolved over 2 months was submitted for medical treatment and diagnosed with intervertebral disk disease at C3-C4 and dorsal extradural compression at C1-C2 and C3-C4 using myelography and computed tomography. The dog experienced ambulation recovery after 15 days of treatment with only electroacupuncture and Chinese herbal medicine, with marked improvement occurring after only 10 treatments. Six months of followup demonstrated that the dog was stable and had no recurrence of symptoms. Therefore, it was concluded that the combination of electroacupuncture and Chinese herbal medicine was responsible for motor rehabilitation.

Abscesos espinales epidurales. Tratamiento combinado médico-quirúrgico. A propósito de 4 casos / Spinal epidural abscesses. Combined medicaland surgical treatment. Report of 4 cases

Los abscesos epidurales espinales (AEE), constituyen una enfermedad de presentación poco frecuente en la atención neuroquirúrgica de nuestro medio, con una morbilidad por déficits neurológicos muy elevada, si las medidas terapéuticas precisas no se toman con celeridad. Esta afección debe ser objeto de estudio, ante todo paciente que la manifieste con dolor en región dorso-lumbar, déficit neurológico y fiebre. Se muestran a 4 pacientes con AEE no tuberculosos ni relacionados con procedimientos quirúrgicos, 2 al nivel lumbar y 2 con inclusión de la región dorso-lumbar, de los cuales 3 presentaron una mala recuperación posoperatoria (entre ellos un fallecido), y uno se recuperó completamente, lo que evidencia la necesidad de tomar una conducta enérgica, desde que se sospeche el diagnóstico. Los autores consideran que la combinación de un tratamiento quirúrgico y médico enérgicos, desde que se comprueba el diagnóstico, independientemente de la severidad del cuadro, es la única garantía de una recuperación adecuada

Granuloma eosinofílico solitário de coluna cervical: relato de caso e revisäo da literatura / Solitary eosinophilic granuloma in the cervical spine: case report and literature review

Os autores apresentam relato de caso de criança portadora de granuloma cosinofílico solitário localizado em coluna cervical ao nível de C3. Realizam ainda revisão da literatura, salientando aspectos como características clínicas, diagnóstico e tratamento desse tipo de lesão.

Síndrome cervical: ensaio com vasodilatador coadjuvando o tratamento físico / Cervical syndrome: test with vasodilator besides physical treatment

O autor faz uma revisäo na fisiopatologia das desordens na coluna cervical e apresenta casuística de 119 pacientes portadores de injúrias cervicais com múltipla sintomatologia. Os pacientes foram divididos em dois grupos: no grupo controle utiliza traçäo cervical e ondas curtas e no grupo teste introduz substância alfa-adrenolítica (Nicergolina), além do tratamento fisiátrico, com o qual obtém melhores resultados na reduçäo de zumbidos e alteraçöes do equilíbrio

Abscesos espinales epidurales. Tratamiento combinado médico-quirúrgico. A propósito de 4 casos / Spinal epidural abscesses. Combined medicaland surgical treatment. Report of 4 cases

Los abscesos epidurales espinales (AEE), constituyen una enfermedad de presentación poco frecuente en la atención neuroquirúrgica de nuestro medio, con una morbilidad por déficits neurológicos muy elevada, si las medidas terapéuticas precisas no se toman con celeridad. Esta afección debe ser objeto de estudio, ante todo paciente que la manifieste con dolor en región dorso-lumbar, déficit neurológico y fiebre. Se muestran a 4 pacientes con AEE no tuberculosos ni relacionados con procedimientos quirúrgicos, 2 al nivel lumbar y 2 con inclusión de la región dorso-lumbar, de los cuales 3 presentaron una mala recuperación posoperatoria (entre ellos un fallecido), y uno se recuperó completamente, lo que evidencia la necesidad de tomar una conducta enérgica, desde que se sospeche el diagnóstico. Los autores consideran que la combinación de un tratamiento quirúrgico y médico enérgicos, desde que se comprueba el diagnóstico, independientemente de la severidad del cuadro, es la única garantía de una recuperación adecuada(AU)