Ventrale Stabilisation einer atlantoaxialen Subluxation mittels Schrauben und Polymethylmetacrylat bei einem Miniatur-Yorkshire-Terrier

Zusammenfassung

Ein 6 Monate alter, weiblicher 1,1 kg schwerer Miniatur-Yorkshire-Terrier wurde aufgrund einer Tetraparese vorgestellt. Auf laterolateralen Röntgenbildern fiel ein vergrößerter Abstand zwischen Processus spinosus des Axis und Arcus dorsalis atlantis bei deutlicher kraniodorsaler Verlagerung und Rotation des kranialen Axiskörpers in Relation zum Atlas auf. Computertomografisch bestätigte sich eine kraniodorsale Verlagerung des kranialen Axis in Relation zum ventralen Atlasbogen im Sinne einer atlantoaxialen Subluxation mit einem nicht fusioniertem Dens axis. Zunächst wurde chirurgisch mit einer dorsalen Muskelnahttechnik versucht, eine entsprechende Reduktion der Subluxation zu erzielen. Da sich die Reduktion röntgenologisch wie auch klinisch als suboptimal erwies, erfolgte eine ventrale Stabilisation mithilfe von 4 1,5-mm-Schrauben in Axis und Atlas sowie Polymethylmetacrylat. Röntgenologisch zeigte sich eine zufriedenstellende Reposition. Der Hund erhielt für 6 Wochen einen stützenden Halsverband. Es kam zu einer progredienten Besserung der neurologischen Symptomatik bis hin zur Symptomfreiheit über bisher 37 Monate.

Abstract

A 6-month-old female Miniature Yorkshire Terrier with a bodyweight of 1.1 kg was presented due to non-ambulatory tetraparesis. Latero-lateral radiographs showed an increased space between the spinal process of the axis and the dorsal arch of the atlas, with craniodorsal displacement and rotation of the body of the axis in relation to the atlas. Computed tomography also revealed a craniodorsal displacement of the axis in relation to the atlas with an unfusioned dens. Initially, a dorsal surgical approach was chosen and an intermuscular suture pattern was used attempting to achieve reduction of the subluxation. Radiographically and clinically the result however was not acceptable. In a second surgery, a ventral stabilization technique (using 4 1.5 mm screws in atlas and axis with polymethylmetacrylate) was performed. The achieved repositioning was considered acceptable. The dog was provided with a cervical bandage for 6 weeks. Clinically, the patient improved progressively and remains free of clinical signs up to the time of manuscript preparation, 37 months post-operatively.

Schlüsselwörter

Atlantoaxiale Instabilität - Miniaturrasse - chirurgische Therapie - Komplikationen - ventrale Fixierung

Key words

Atlantoaxial instability - miniature breed - surgical therapy - complications - ventral fixation

Publikationsverlauf

Eingereicht: 25. März 2019

Angenommen: 07. August 2019

Artikel online veröffentlicht:
06. Dezember 2019

• Literatur

• 1 Aikawa T, Shibata M, Fujita H. Modified ventral stabilization using positively threaded profile pins and polymethylmethacrylate for atlantoaxial instability in 49 dogs. Vet Surg 2013; 42: 683-692
• 2 Beaver DP, Ellison GW, Lewis DD. et al. Risk factors affecting the outcome of surgery for atlantoaxial subluxation in dogs: 46 cases (1978–1998). J Am Vet Med Assoc 2000; 216 (07) 1104-1109
• 3 Cerda-Gonzalez S, Dewey CW. Congenital diseases of the craniocervical junction in the dog. Vet Clin North Am Small Anim Pract 2010; 40 (01) 121-141
• 4 Cerda-Gonzalez S, Dewey CW. et al. Imaging features of atlanto occipital overlapping in dogs. Vet Radiol Ultrasound 2009; 50 (03) 264-268
• 5 Chambers JN, Betts CW, Oliver JE. The use of non-metallic suture material for stabilization of atlantoaxial subluxation. J Am Anim Hosp Assoc 1977; 13: 602-604
• 6 Denny HR, Gibbs C, Waterman A. Atlantoaxial subluxation in the dog: a review of thirty cases and evaluation of treatment by lag screw fixation. J Small Anim Pract 1988; 29: 37-47
• 7 Dewey CW, Marino DJ, Loughin CA. Craniocervical junction abnormalities in dogs. N Z Vet J 2013; 61 (04) 202-211
• 8 Dickomeit M, Alves L, Pekarkova M. et al. Use of a 1.5 mm butterfly locking plate for stabilization of atlantoaxial pathology in three toy breed dogs. Vet Comp Orthop Traumatol 2011; 24: 246-251
• 9 Forterre F, Vizcaino Revés N, Stahl C. et al. An indirect reduction technique for ventral stabilization of atlantoaxial instability in miniature breed dogs. Vet Comp Orthop Traumatol 2012; 25: 332-336
• 10 Geary J, Oliver J, Hoerlein BF. Atlantoaxial subluxation in the canine. J Small Anim Pract 1967; 8: 577-582
• 11 Havig ME, Cornell KK, Hawthorne JC. et al. Evaluation of nonsurgical treatment of atlantoaxial subluxation in dogs: 19 cases (1992–2001). J Am Vet Med Assoc 2005; 227 (02) 257-262
• 12 Jeffery ND. Dorsal cross pinning of the atlantoaxial joint: new surgical technique for atlantoaxial subluxation. J Small Anim Pract 1996; 37: 26-29
• 13 Kishigami M. Application of an atlantoaxial retractor for atlantoaxial subluxation in the cat and dog. J Am Anim Hosp Assoc 1984; 20: 413-419
• 14 Leblond G, Moens NMM, Gaitero L. et al. Computed tomography and biomechanical comparison between transarticular screw fixation and 2 polymethylmethacrylate cemented constructs for ventral atlantoaxial stabilization. Vet Comp Orthop Traumatol 2018; 31: 344-355
• 15 LeCouteur RA, McKeown D, Johnson J. et al. Stabilization of atlantoaxial subluxation in the dog, using the nuchal ligament. J Am Vet Med Assoc 1980; 177: 1011-1017
• 16 Lin JL, Coolman BR. Atlantoaxial subluxation in two dogs with cervical block vertebrae. J Am Anim Hosp Assoc 2009; 45: 305-310
• 17 Mc Carthy RJ, Lewis DD, Hosgood G. Atlantoaxial subluxation in dogs. Compend Contin Educ Pract 1995; 17: 215-227
• 18 Middleton G, Hillman DJ, Trichel J. et al. Magnetic resonance imaging of the ligamentous structures of the occipitoatlantoaxial region in the dog. Vet Radiol Ultrasound 2012; 53: 545-551
• 19 Platt SR, Chambers JN, Cross A. A modified ventral fixation for surgical management of atlantoaxial subluxation in 19 dogs. Vet Surg 2004; 33: 349-354
• 20 Platt S, Olby N. eds. BSAVA Manual of Canine and Feline Neurology. 4th ed.. Gloucester: BSAVA; 2013
• 21 Pujol E, Bouvy B, Omaña M. et al. Use of the Kishigami atlantoaxial tension band in eight toy breed dogs with atlantoaxial subluxation. Vet Surg 2010; 39: 35-42
• 22 Renegar WR, Stoll SG. The use of methylmethacrylate bone cement in the repair of atlantoaxial subluxation stabilization failures – case report and discussion. J Am Anim Hosp Assoc 1979; 15: 313-318
• 23 Sánchez-Masian D, Luján-Feliu-Pascual A, Font C. et al. Dorsal stabilization of atlantoaxial subluxation using nonabsorbable sutures in toy breed dogs. Vet Comp Orthop Traumatol 2014; 27: 62-67
• 24 Sanders SG, Bagley RS, Silver GM. et al. Outcomes and complications associated with ventral screws, pins, and polymethyl methacrylate for atlantoaxial instability in 12 dogs. J Am Anim Hosp Assoc 2004; 40: 204-210
• 25 Schulz KS, Waldron DR, Fahie M. Applicaton of ventral pins and polymethylmethacrylate for the management of atlantoaxial instability: results in nine dogs. Vet Surg 1997; 26: 317-325
• 26 Sharp N, Wheeler S. eds. Small Animal Spinal Disorders. 2nd ed.. London: Elsevier Mosby; 2004
• 27 Shores A, Tepper LC. A modified ventral approach to the atlantoaxial junction in the dog. Vet Surg 2007; 36: 765-770
• 28 Sorjonen DC, Shires PK. Atlantoaxial instability: a ventral surgical technique for decompression, fixation and fusion. Vet Surg 1981; 1: 22-29
• 29 Stalin C, Gutierrez-Quintana R, Faller K. et al. A review of canine atlantoaxial joint subluxation. Vet Comp Orthop Traumatol 2015; 28: 1-8
• 30 Takahashi F, Hakozaki T, Kouno S. et al. Atlantooccipital overlapping and its effect on outcomes after ventral fixation in dogs with atlantoaxial instability. J Vet Med Sci 2018; 80 (03) 526-531
• 31 Thomas WB, Sorjonen DC, Simpson ST. Surgical management of atlantoaxial subluxation in 23 dogs. Vet Surg 1991; 20: 409-412
• 32 Vizcaíno Revés N, Stahl C, Stoffel M. et al. CT scan based determination of optimal bone corridor for atlantoaxial ventral screw fixation in miniature breed dogs. Vet Surg 2013; 42: 819-824
• 33 Waschk MA, Vidondo B, Carrera I. et al. Craniovertebral junction anomalies in small breed dogs with atlantoaxial instability: a multicenter case-control study. Vet Comp Orthop Traumatol 2019; 32: 33-40