Hirurški pristup bolesti intervertebralnog diska – moja iskustva

Abstract

Bolest intervertebralnog diska je jedno od najčešćih neuroloških stanja koje srećemo kod pasa, ređe kod mačaka. Hondrodistrofične rase kao što su jazavičari, francuski buldozi kao i psi rase ši-cu su predisponirani za ova stanja, koja se manifestuju bolom , parezom ili paralizom prednjih i zadnjih ekstremiteta. Pored ovih rasa, patologiju intervertebralnog diska srećemo kod biglova i nemačkih ovčara. Takvo stanje značajno utiče na kvalitet života. Međupršljenski diskovi su želatinozne mase okružene fibroznim omotačem koje amortizuju i ublažavaju frikciju izmedju pršljenova. Tipični problem se dešava kada sadržaj diska izadje u intervertebralni kanal i na taj način uzrokuje kompresiju kičmene moždine. Bolest intervertebralnog diska može biti akutna, Hansen I, gde dolazi do ekstruzije unutrašnjeg sadržaja diska ili hronična, odnosno Hansen II, pri čemu dolazi do protruzije spoljašnjeg fibroznog omotača diska. Klinički znaci su najčešće bol u vratu, ledjima, ataksija, slabost i u krajnjoj situaciji paraliza ekstremiteta. Dijagnoza se postavlja na osnovu kliničke slike i naprednih tehnika snimanja. Kompjuterizovana tomografija (CT), kao i magnetna rezonanca su najbolji način postavljanja dijagnoze. Ovim snimanjem ustanovljava se tačna patologija i lokalizacija procesa. Kod velikog broja pacijenata do oporavka dolazi konzervativnim metodama lečenja, ali se smatra da je procent uspešnosti oporavka pacijenata nakon hirurške intervencije blizu 95%. Najčešće hirurške procedure koje se obavljaju su fenestracija diska i dekompresija kičmene moždine. Dekompresija kičmene moždine u nivou vratnog dela kičme obavlja se sa ventralne strane tzv. Ventral slot, dok se u nivou torakolumbalnog dela kičme najčešće vrši hemilaminektomija.

Intervertebral disc disease is one of the most common neurological conditions that we encounter in dogs, less often in cats. Chondrodistrophic breeds such as dachshunds, French bulldogs as well as dogs of the shi-tzu breed are predisposed to these conditions, which are manifested by pain, paresis or paralysis of the anterior and posterior extremities. In addition to these breeds, the pathology of the intervertebral disc is encountered in beagles and German shepherds. Such a situation significantly affects the quality of life. The intervertebral discs are gelatinous masses surrounded by a fibrous sheath that depreciates and relieves friction between the vertebrae. A typical problem occurs when the contents of the disc go out into the intervertebral canal and thus cause compression of the spinal cord. Intervertebral disc disease can be acute, Hansen I, where extrusion of the internal contents of the disc occurs or chronic, i.e. Hansen II, whereby protrusion of the outer fibrous membrane of the disc occurs. Clinical signs are most often pain in the neck and back, ataxia, weakness and, in extreme situation, paralysis of the extremities. The diagnosis is made on the basis of clinical picture and advanced imaging techniques. Computed tomography (CT) as well as magnetic resonance imaging are the best way to diagnose. This type of scaning establishes the exact pathology and localization of the process. In a large number of patients, recovery occurs with conservative methods of treatment, but the percentage of success of recovery of patients after surgical intervention is considered to be close to 95%. The most common surgical procedures performed are disc fenestration and decompression of the spinal cord. Decompression of the spinal cord at the level of the cervical spine is performed from the ventral side of the so-called Ventral slot, while in the level of the thoracolumbar part of the spine, hemilaminectomy is more common.