Abstract
AbstractSurgical repair of fractures and luxations of the cranial cervical vertebrae can be complicated by vertebral venous plexus hemorrhage following fracture fragment manipulation and realignment. Severe hemorrhage is potentially life threatening and may preclude definitive surgical fixation if it cannot be acceptably controlled and interferes with fixation technique. This report describes this scenario and a surgical strategy in two dogs with fractures of the second cervical vertebra. The surgical technique to limit hemorrhage included the insertion of the pins into the vertebrae, placement of collagen fleece, and autogenous cancellous bone graft over the fracture site, and while the polymethylmethacrylate cement was still within the liquid phase, axial traction was employed. The long-term outcome was considered excellent with both dogs able to ambulate unassisted and free from signs of pain. Although it is uncommon, severe vertebral venous plexus hemorrhage can occur during cervical vertebrae fracture repair. This technique provides a means to achieve internal fixation while concurrently limiting hemorrhage.
Highlights
Cervical fractures and luxations in dogs are diagnosed infrequently
A more recent review of outcomes following spinal fracture and luxation in dogs and cats has documented surgical management with pins and polymethylmethacrylate (PMMA) cement which was associated with a significantly greater improvement in neurological status when compared with conservatively managed patients.[3]
The most frequently performed surgical technique for fractures of the cervical spinal vertebrae includes the use of ventrally applied pins into the vertebrae with the ends enshrouded in PMMA cement.[3,5,6,7]
Summary
Cervical fractures and luxations in dogs are diagnosed infrequently. Most cervical fractures are caused by severe trauma such as vehicular impact, colliding while running, or falling from a height.[1,2] Subsequently, trauma sufficient to cause these injuries is often fatal or leaves a poor prognosis prompting euthanasia.[3,4] Reported treatment options include conservative management or surgery; controversy has historically surrounded which of these treatments will provide the best outcome.[2,5,6] A more recent review of outcomes following spinal fracture and luxation in dogs and cats has documented surgical management with pins and polymethylmethacrylate (PMMA) cement which was associated with a significantly greater improvement in neurological status when compared with conservatively managed patients.[3]. E2 Surgical Management of Cervical Vertebral Fractures Guthrie, Fitzpatrick and stabilization by distracting the vertebrae while cement is in a liquid phase. Surgical Management of Cervical Vertebral Fractures Guthrie, Fitzpatrick e3 and packed into the articular facets of C1–C2 following cartilage debridement (►Fig. 2). There was no decline in neurological status following surgery and by 6 weeks postoperatively, the patient was considered to be clinically normal; radiographs and CT demonstrated no implant disruption and progression toward osseous union of the fracture. Surgical Management of Cervical Vertebral Fractures Guthrie, Fitzpatrick e5 immediately cranial and caudal to the fracture site These wires were passed through a multidirectional adjustable jig (Orthopaedic Distractor Ref: 001500; Veterinary Instrumentation, Sheffield, UK; ►Fig. 6). At 6 weeks postsurgery, mild paresis remained; postural reactions of the
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