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Reduction and Fixation of Cranial Cervical Fracture/Luxations using Screws and Polymethylmethacrylate (PMMA) Cement: A Distraction Technique Applied to the Base of the Skull in Thirteen Dogs

Authors

  • Fred S. Pike DVM, Diplomate ACVS,

    1. Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
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  • M. S. A. Kumar BVSc, MVSc, MS, PhD,

    1. Biomedical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
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  • Randy J. Boudrieau DVM, Diplomate ACVS & ECVS

    Corresponding author
    • Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
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  • Presented in part at the 34th Annual Conference of the Veterinary Orthopedic Society, Sun Valley, ID, March 3–10, 2007.

Corresponding Author

Randy J. Boudrieau, DVM, Diplomate ACVS & ECVS, Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, N. Grafton, MA 01536

E-mail: randy.boudrieau@tufts.edu

Abstract

Objective

To (1) describe a surgical distraction technique for C1-2 cervical fractures/luxations or atlantoaxial (AA) subluxations using the base of the skull (basion of the foramen magnum) and either C2-3 or C3-4 for the purchase points of intraoperative axial distraction and (2) report outcome in 13 dogs.

Study Design

Retrospective case series.

Animals

Dogs (n = 13).

Materials and Methods

Medical records (September 1995–December 2005) of dogs with fracture/luxation of the cervical spine, or AA subluxations, were reviewed. Only dogs that had intraoperative linear distraction using the base of the skull as a purchase point for a self-retaining retractor were included. Signalment, presenting neurologic deficits, fracture location, and concurrent injury were recorded. Both short-term in-hospital follow-up, including healing and any complications, and long-term telephone follow-up were obtained.

Results

Realignment of the spinal vertebrae, reestablishing the normal properties of the spinal canal, was achieved after distraction in all dogs. Screws and small pins incorporated into polymethylmethacrylate cement were used to span the fracture ventrally and achieve rigid internal fixation. Eight dogs had a complete neurologic recovery, 2 dogs had slight residual ataxia, 2 dogs died, and 1 dog was lost to follow-up. Healing was good (mean, 7.5 weeks) or excellent (mean, 5.1 months) based on in-hospital follow-up (mean, 5.1 months). On final telephone follow-up (mean, 7.7 years), no dogs were reported to have had any associated problems or additional surgery.

Conclusions

This surgical distraction technique was a reliable, relatively simple method to obtain reduction of fracture/luxations of C1-2 to re-align the spinal canal. Mortality in this series appears lower than that previously reported and supports surgical management of these injuries.

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