Plasma rico en plaqueta en el tratamiento de la enfermedad degenerativa discal / Platelet-rich plasma in the treatment of degenerative disc disease

Introducción: La enfermedad degenerativa discal es una entidad frecuente y uno de los principales motivos de consulta. Genera altas tasas de discapacidad, años útiles perdidos, así como altos costos económicos por asistencia médica y grandes pérdidas monetarias. Su tratamiento es generalmente conservador, aunque en la actualidad se incluyen terapias biológicas novedosas. Objetivo: Describir las principales propiedades biológicas que hacen del plasma rico en plaquetas una terapéutica efectiva para la enfermedad degenerativa discal. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, LILACS; en idioma español, inglés y portugués, durante los últimos diez años. Desarrollo: Se expusieron características clínico epidemiológicas de la enfermedad degenerativa discal, así como las propiedades biológicas que le permiten al plasma rico en plaqueta tener una función activa en la regeneración del disco intervertebral o el retraso de la cascada de degradación de este. Se resaltan los principales estudios de acuerdo a la vía de administración del plasma rico en plaquetas y sus resultados. Conclusiones: De acuerdo con lo publicado por los autores, el plasma rico en plaquetas es una alternativa efectiva en el tratamiento de la enfermedad degenerativa discal por la producción de factores derivados de las plaquetas, que intervienen en la degeneración del disco intervertebral, siendo la vía intradiscal la que más se emplea(AU)

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used(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 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)

Funcionalidad, calidad de vida y grado de dolor en 243 pacientes con lumbalgia crónica degenerativa / FUNCTIONALITY, QUALITY OF LIFE, AND PAIN INTENSITY IN 243 PATIENTS WITH DEGENERATIVE CHRONIC LUMBAR DISEASE

Introducción: La enfermedad degenerativa lumbar ocasiona lumbalgia, es la patología musculo esquelética más frecuente en mayores de 65 años, la segunda causa de las consultas médicas en primer nivel, quinta en admisión en hospitales y tercera de cirugía de columna lumbar que ocasiona incapacidad y limitación de actividades cotidianas. El objetivo es correlacionar la calidad de vida con limitación funcional en pacientes con lumbalgia crónica degenerativa. Metodología: estudio transversal, en 243 adultos mayores con lumbalgia degenerativa, de ambos géneros, mayores de 65 años, con lumbalgia crónica y limitación funcional de actividades cotidianas. Se utilizó Escala Visual Analógica (EVA), Cuestionario de Salud SF-36 y Escala de Incapacidad por Dolor Lumbar de OSWESTRY. La estadística fue descriptiva y correlación Spearman. Resultados: N=273, edad media 77 ± 6.9 años, 63.38% fueron mujeres, 48.97% pensionados, 20.17% analfabetas, 25.10% nivel secundaria, 65.85% casados. En el SF-36: calidad de vida promedio 39.2, con mayor afectación en el dominio de funcionamiento social: media 51.99; OSWESTRY: imitación funcional mínima y moderada en 23.9%, limitación severa a máxima en 76.1%; EVA: 59.3% dolor leve a moderado y 40.7% dolor intenso y con el peor dolor posible; hubo correlación negativa entre SF-36 y OSWESTRY: -.830, p=0.000; tambien correlación negativa entre calidad de vida y grado de dolor: -.798 p<0.0001 y correlación positiva entre limitación funcional y grado de dolor: 0.734 p=0.000. Conclusión: La calidad de vida tiene correlación negativa con limitación funcional y dolor; la correlación entre limitación funcional y dolor es positiva en adultos mayores con lumbalgia crónica

Introduction: Lumbar degenerative disease causes lumbago, is the most common muscleskeletal pathology in patients over 65 yearsold and the second leading cause of medical consultations at first medical level, the fifth in hospital admissions and third of lumbar spine surgery. It causes disability and limitation of daily activities. The objective is to correlate the quality of life with functional limitation in patients with Atraumatic Chronic Lumbago. Methods: Cross-sectional study in 243, older than 65 years old, male and female, with Atraumatic Chronic Lumbago and functional limitation of daily activities. Visual Analog Scale (VAS), SF-36 and Oswestry questionaries were applied. Descriptive and correlation statistics were used. Results: N=273, mean age 77 ± 6.9 years, 63.38% women, 48.97% pensioners, 20.17% illiterate, 25.10% High School level and 65.85% were married. SF-36: 39.2 quality of life average was 39.2, with greater involvement in the social functioning domain: 51.99 media. OSWESTRY: moderate and low functional limitation in 23.9%, severe to maximum limitation in 76.1%; VAS mild to moderate pain in 59.3% and 40.7% severe pain and worst pain possible; there were negative correlation between SF -36 and OSWESTRY -.830, p= 0.000 and between quality of life and degree of pain: -.798 p < 0.0001; correlation between and positive degree of functional limitation and degree of pain was positive: 0.734 p=0.000. Conclusion: Quality of life is negatively correlated with pain and functional limitation; and the correlation between pain and functional limitation is positive in older adults with chronic low back pain

Transplantation of adipose derived mesenchymal stem cells for acute thoracolumbar disc disease with no deep pain perception in dogs

Thirty-four dogs with no deep pain perception due to acute thoracolumbar intervertebral disc disease underwent decompression surgery within 1 week of diagnosis. All dogs underwent hemilaminectomy. Adipose derived mesenchymal stem cells (AD-MSCs) were transplanted into the injured spinal cord parenchyma for the AD-MSCs transplant dogs. Long-term outcome was evaluated at the end of the follow-up period (> 6 months). AD-MSCs combination treatment showed better recovery outcomes compared to decompression surgery alone. These results indicate that this stem cell therapy is a potential therapeutic strategy to overcome the limitations of treatment for spinal cord injury in clinical medicine.

Escoliosis degenerativa del adulto / Degenerative adult scoliosis

La escoliosis del adulto es una deformidad rotacional compleja tridimensional de la columna, resultado de la degeneración progresiva de los elementos vertebrales en la edad madura, en una columna previamente recta; con un ángulo de Cobb mayor de 10º en el plano coronal, que además altera los planos sagital y axial. Se origina de una enfermedad degenerativa, asimétrica del disco y las facetas articulares, creando cargas asimétricas y posteriormente deformidad. El síntoma principal es dolor axial, radicular y déficit neurológico. El tratamiento conservador incluye fármacos y terapia física. Las infiltraciones epidurales y facetarias para bloqueo selectivo de raíces nerviosas mejora el dolor a corto plazo. El tratamiento quirúrgico se reserva para pacientes con dolor intratable, radiculopatía y/o déficit neurológico. No existe un consenso para las indicaciones quirúrgicas, sin embargo, se debe tener un entendimiento claro de los síntomas y signos clínicos. La meta de la cirugía es la descompresión de elementos neurales con restauración, modificación de la deformidad en forma tridimensional y estabilización del balance coronal y sagital.

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10º in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and / or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia / Avaliação do equilíbrio espinopélvico em pacientes submetidos a tratamento cirúrgico de hérnia de disco lombar

OBJECTIVE: to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment. METHODS: thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that needed to encompass the lumbar spine, sacrum and proximal third of the femur. RESULTS: the spinopelvic balance measurements obtained from the mean angles of the population studied, for pelvic incidence, sacral slope and pelvic tilt, were 45◦ , 36.9◦ and 8.1◦ , respectively. The confidence interval for the mean pelvic incidence was from 41.9 to 48.1 (95% CI), thus including a reference value that characterized it as low, for an asymptomatic population, thus confirming that the sample was extracted from a population with this characteristic. CONCLUSION: among these patients with lumbar disk hernias who underwent surgical treatment, the average spinopelvic balance was found to have pelvic incidence lower than what has been reported in the literature for an asymptomatic population...

OBJETIVO: avaliar o equilíbrio espinopélvico, por meio da incidência pélvica, do declive sacral e da versão pélvica, em pacientes portadores de hérnias discais lombares submetidos a tratamento cirúrgico. MÉTODOS: foram avaliados 30 pacientes do Serviço de Coluna Vertebral do Hospital Santa Casa de Misericórdia de Vitória e do Vila Velha Hospital, por meio da aferição do equilíbrio espinopélvico, obtido pela mensuração dos ângulos da versão pélvica, do declive sacral e da incidência pélvica, com suas respectivas médias, nas radiografias simples lombopélvicas, tipo perfil, que englobaram, obrigatoriamente, coluna lombar, sacro e terço proximal do fêmur. RESULTADOS: a medida do equilíbrio espinopélvico, obtida pela média dos ângulos na população estudada da incidência pélvica, do declive sacral e da versão pélvica, foi de 45◦ , 36,9◦ e 8,1◦ , respectivamente. O intervalo de confiança da média da incidência pélvica entre 41,9 - 48,1 (95% IC) contém o valor de referência que a caracteriza como baixa, para uma população assintomática, o que confirma que a amostra foi extraída de uma população com essa característica. CONCLUSÃO: nos pacientes portadores de hérnia discal lombar submetidos a tratamento cirúrgico foi encontrado, em média, um equilíbrio espinopélvico com incidência pélvica abaixo do encontrado na literatura para uma população assintomática...