Laminectomy for relief of atlantoaxial subluxation in four horses

Malalignment of the atlas and axis was seen in 4 horses with an idiopathic form of atlantoaxial subluxation characterized by spinal cord compression on extension. The bone structure and density of the atlas and axis were radiographically normal in 3 of the 4 horses. Clinical signs appeared when the horses were 6 to 30 months old, and 3 of the 4 horses had a history of trauma. Although a congenital anomaly could not be ruled out, the cause was thought to be trauma. The horses were moderately to severely ataxic at the time of examination. Myelography revealed compression of the spinal cord at the atlantoaxial junction on extension. Flexion completely relieved the compression. In each horse, subtotal laminectomy of the caudal two thirds of the dorsal arch of the atlas was used to relieve the spinal cord compression. Two horses recovered fully, one had residual grade-1 neurologic deficits, and a fourth was euthanatized after it fractured a limb 6 weeks after surgery.     

Congenital occipitoatlantoaxial malformations in the horse

From a clinical, radiological and morphological study of 9 horses with congenital malformations of the occiput, atlas and axis, and from a study of 2 reported cases, 3 diseases were defined: A. Familial occipitalisation of the atlas with atlantalisation of the axis in Arabian horses (7 cases in this report and the case reported by Leipold, et al., 1974). These horses had congenital atlantooccipital fusion, hypoplasia of the atlas and dens, malformation of the axis and modification of the atlantoaxial joint. B. Congenital asymmetrical occipitoatlantoaxial malformation (2 cases in this report). A Standardbred and a Morgan horse had atlantooccipital fusion, a wedge shaped vertebral piece attached to the caudal end of the axis and sigmoid scoliosis of the cervical vertebrae. C. Asymmetrical atlantooccipital fusion (the case reported by Schmaltz, 1915). This horse of an unknown breed had asymmetrical fusion between the atlas and occiput and cervical scoliosis. The clinical syndromes shown by horses with these malformations were variable but were broadly classified as: 1. Foal dead at birth, seen in one foal with A. 2. Tetraparesis at birth, seen in 5 foals with A. These foals were born with signs varying from tetraparesis to tetraplegia. 3. Progressive ataxia, seen in 2 foals with A. Clinical signs were due to a progressive focal cervical compressive myelopathy. 4. Congenital cervical scoliosis/deviated head, seen in the 2 horses with B and the horse with C. These horses had no signs of spinal cord or brain disease. The diagnoses were made clinically by palpation of the occipitoatlantoaxial region and were confirmed radiographically and/or by post mortem examination in all except one case. Pedigree analysis showed the familial nature of the particular occipitoatlantoaxial malformation seen in horses of only the Arabian breed.     

Postnatal ossification centers of the atlas and axis in miniature schnauzers

Postnatal ossification of the atlas and axis was studied in Miniature Schnauzers by examining alizarin-stained bone clearings, cleaned dry bones, radiographs, histologic sections, and arterially perfused bone clearings. Sixty-two pups (1 day to 16 weeks old) and 4 adults were examined. In 1-day-old pups, the atlas consisted of 3 separate ossification centers: a left and right neural arch center and midventrally, the intercentrum 1, which formed the body of the atlas. The axis contained 4 separate ossification centers: a left and right neural arch center; centrum 2 in the main part of the axis body; and centrum 1, which formed the caudal part of the dens and the cranial part of the axis body. By 6 weeks of age, the epiphysis on the caudal end of the axis body had begun to ossify. At this time, the intercentrum 2, which developed as a cuboidal ossification center intercalated between centrum 1 and centrum 2 in the middle of the cranial half of the axis body, also began to ossify. The centrum of the proatlas, which formed the apex of the dens, was first seen ossified in a 9-week-old pup. These 10 ossification centers were seen as constant and separate elements. In all dogs, the dens developed from 2 separate ossification centers: the centrum of the proatlas formed the cranial one-quarter, and centrum 1 formed the caudal three-quarters. Dens dysplasia is unlikely to be a result of failure of development of one of the ossification centers for the dens.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cervical Intervertebral Disk Protrusion in a Horse

A Hansen type ll intervertebral disk protrusion was diagnosed in an 18-year-old horse with signs of progressive ataxia and paresis. A soft tissue mass dorsal to the C6-C7 intervertebral disk space was identified at myelogram and found to be an intervertebral disk protrusion with enlarged dorsal annulus fibrosis at surgery. Surgical decompression was achieved using a ventral approach to the caudal cervical vertebrae, an approach limited in its application by the vertebral venous sinuses. Neurological signs remained unchanged for 3 days and then deteriorated. The horse was euthanized.     

Chronic Atlantoaxial Luxation Imaging Features in a Pony with Intermittent Neck Stiffness

A 17-year-old mixed breed pony was presented with intermittent neck stiffness during regular training rides in the six months preceding its admission. All parameters were within the normal range, except for an increase in heart rate (48 bpm) during the examination. Concave areas were observed at the level between the atlas and axis vertebrae (C1-C2) on both the left and right sides of the neck. Radiographs were taken of the laterolateral, left ventrodorsal oblique, and right ventrodorsal oblique projections in the cranial cervical region. The images revealed severe structural disorders, including trauma with luxation of the atlantoaxial joint, a fusion of the atlas and axis vertebrae, and evidence of a false joint in the axis bone. Subsequent ultrasonography showed hyperechoic areas in the rectus capitis caudalis and obliquus capitis caudalis muscles. Neck mobility was improved after two weeks of stall rest, administration of oral phenylbutazone (4.4 mg/kg), and topical cold gel treatment. The overstretching of surrounding soft tissues accompanying chronic injury of cranial cervical area may result in neck stiffness in the aging pony. Radiographic and ultrasonographic findings were consistent with the presence of cranial cervical trauma leading to neck stiffness. These findings emphasized the essential role of imaging diagnostics in treating a pony with intermittent neck stiffness.     

Skeletal aspects of the atlanto-occipital fusion in a Japanese brown calf.

Atlanto-occipital fusion in a Japanese Brown calf was examined morphologically, paying special attention to skeletal changes. At the craniovertebral junction, the basal occipital bone fused to the cranial extremity of the ventral arch of the atlas with the rudiment of the atlantal centrum. The dens was not formed at the axis. These changes suggest that a hypocentrum and a centrum of the atlas derived from the first cervical sclerotome had failed to separate the occipital base from the proatlantal sclerotome including the apical element of the dens. Although a developmental disturbance at the cervical and thoracic vertebrae was also associated, critical neurological signs such as ataxia and paralysis were absent.     

The Foramina of the Cervical Vertebrae of the Ox

All the macroscopically visible foramina of the atlas and axis in 20 oxen are examined and their size, incidence and connections described. The atlas possesses a canal connecting the atlantal fossa with the vertebral foramen. It is suggested that it be named “Canalis vertebroalaris”. The axis contains a prominent transverse canal rather than a foramen, with “cranial” and “caudal transverse foramina”. The canal occurs in an atypical location in 25 % of cases.     

Laminotomy of the Axis for Surgical Access to the Cervical Spinal Cord A Case Report

A cranially hinged laminotomy of vertebra C2 was used to expose the cervical spinal cord of a dog with a meningioma in the region of the atlantoaxial articulation. By preserving the dorsal atlantoaxial ligament, the technique seemed to result in greater and more physiologic stability between the atlas and axis than dorsal laminectomy and prosthetic replacement of the dorsal atlantoaxial ligament. The procedure allowed a dorsal approach, avoiding injury to the vertebral arteries and limited exposure, which are potential problems with hemilaminectomy of C1-C2. Further investigation is needed to evaluate long-term consequences of this procedure.     

Occipitoatlantoaxial malformation with duplication of the atlas and axis in a half Arabian foal

An unusual occipitoatlantoaxial malformation is described in a 2-week-old male part Arabian foal that was unable to stand at birth and showed signs of spastic tetraparesis due to a cervical spinal cord compression. There were 2 atlases present. One was fused to the occipital bones. The other articulated with the first atlas and an axis which had a long dens that projected into the vertebral canal. Examination of the ossification centers of the axis indicated partial duplication of that bone.     

STANDING MYELOGRAPHY IN THE HORSE USING A NONIONIC CONTRAST AGENT

Standing myelography in the horse has been previously described. In that study, metrizamide was used and significant complications were reported. In recent years, the introduction of less-toxic nonionic contrast media has reduced the incidence of complications. This study was undertaken to determine whether standing myelography using a nonionic contrast medium could provide a diagnostic study and be performed safely in the equine patient. Standing myelography was performed in eight horses. The contrast medium used was iohexol. In five horses a myelogram of diagnostic quality was achieved; in one horse contrast flowed only to the level of C6 and in two horses contrast medium did not reach the cervical subarachnoid space. Owing to the difficulty in achieving good flow of the contrast medium in some horses, this procedure may be of limited utility. However, if puncture of the lumbosacral subarachnoid space can be achieved easily and quickly, standing myelography may be a clinically useful procedure. It may be attempted in cases in which the economic value of the patient makes myelography under general anesthesia impractical. In patients presenting for evaluation of ataxia it may be possible to perform a standing myelogram at the time of CSF sample collection from the lumbosacral space.     

Atlantoaxial malformation in a half-Arabian colt

A 1-year-old half-Arabian colt was referred for evaluation of a cranial cervical abnormality. Physical examination revealed the left wing of the atlas to be more ventral than the right wing. A head tilt, with the pole deviated to the left, was present because of the malpositioned atlas. Neurologic examination identified symmetrical weakness, ataxia, and proprioceptive deficits in all four limbs. Radiographs of the cranial cervical region revealed fusion of the atlas and axis, and deviation of the atlantoaxial joint to the left of the median plane. Euthanasia was elected. Necropsy confirmed the radiographic findings. The atlas was rotated 20 degrees counterclockwise when viewed from the caudal aspect. Multifocal myelomalacia was present in the first and second cervical spinal cord segments. The malformation was believed to be due to a degenerative process or abnormal embryological development.     

Cervical stenotic myelopathy in a horse

A 13-year-old, Thoroughbred gelding presented with a 3-year history of progressive ataxia of all 4 limbs. Physical and neurological examinations indicated a compressive lesion affecting the cervical spinal cord. Radiographs confirmed a lesion, and a myelogram a narrowing of the spinal canal at cervical vertebrae (6-7). Necropsy confirmed cervical stenotic myelopathy.     

INCOMPLETE OSSIFICATION OF THE ATLAS IN DOGS WITH CERVICAL SIGNS

Osseous defects affecting the atlas were identified in computed tomography and magnetic resonance images of five dogs with cervical signs including pain, ataxia, tetraparesis, or tetraplegia. Osseous defects corresponded to normal positions of sutures between the halves of the neural arch and the intercentrum, and were compatible with incomplete ossification. Alignment between the portions of the atlas appeared relatively normal in four dogs. In these dogs the bone edges were smooth and rounded with a superficial layer of relatively compact cortical bone. Displacement compatible with unstable fracture was evident in one dog. Concurrent atlantoaxial subluxation, with dorsal displacement of the axis relative to the atlas, was evident in four dogs. Three dogs received surgical treatment and two dogs were treated conservatively. All dogs improved clinically. Incomplete ossification of the atlas, which may be associated with atlantoaxial subluxation, should be considered in the differential diagnosis of dogs with clinical signs localized to the cranial cervical region.     

Surgical decompression for traumatic atlantoaxial subluxation in a weanling filly.

A filly with ataxia and splinting and crepitation in the neck was found to have atlantoaxial subluxation. Radiographic diagnosis was based on the same criteria as those used in other species, ie, increased distance between the atlas and spine of the axis and increased distance between the dens and floor of the atlas. Extensive hemilaminectomy was performed to decompress the spinal cord. Stabilization was not attempted. Immediate postoperative response was encouraging, but the untimely death of the filly prevented further evaluation of the procedure.     

X-ray and CT morphology of atlas variants in the dog

To investigate variations in atlas shape in dogs the image archives of the Department for Small Animals and Horses, University of Vienna, and The Royal Veterinary College, University of London were searched for radiographs and CT images of the canine atlas. 32 radiographic and 78 CT studies, including 51 toy and 54 large breed dogs, were retrieved and analysed. Five dogs had both radiographs and CT scans. Patients with pathologic alterations, such as fractures and incomplete ossification of the atlas, as well as oblique projections were excluded. Compared to large breed dogs (body weight more than 30 kg) the atlas of toy breed dogs (body weight less than 10 kg) had a reduced craniocaudal and an increased dorsoventral diameter. The vertebral longitudinal axis appeared to be dorsorotated, resulting in a steeper rise of the atlas wings and a more dorsally located lateral vertebral foramen. When comparing the atlas of toy and large breed dogs, the distribution of three morphologic parameters was statistically different: Ratio length to height (toy breeds > 1, large breeds < or = 1), shape of the vertebral chanal (toy breeds: vertically oval, large breeds: round resp. cross-oval, or vertically oval) and trabecular bone of the dorsal arch (toy breeds: absent, large breeds: present). There was no significant difference in the morphology of the ventral arch. Differences in atlas morphology could contribute to the predisposition of toy breed dogs to atlanto-axial instability; however, further studies are necessary to test this hypothesis.     

Postoperative complication of cervical fracture repair in a dog

Fracture and luxation of the second cervical vertebra of a dog were repaired with braided polyester sutures. After 28 months, the dog became ataxic. Compression of the spinal cord at C1-2 was seen on a myelogram. Surgical exploration of the area revealed a granuloma associated with the sutures and compressing the spinal cord. After the granuloma was removed, the dog recovered and has remained neurologically normal for 21 months. The abnormal tissue was determined histologically to be a pyogranuloma.     

Hemorrhage in the central canal of the cervical spinal cord in a coonhound diagnosed with canine juvenile polyarteritis (steroid responsive meningitis-arteritis)

Patchy meningeal and parenchymal contrast enhancement of the spinal cord with multifocal central canal dilations was noted in a computed tomography myelogram of the cervical spine of a 6-month-old intact female coonhound with a confirmed diagnosis of canine juvenile polyarteritis and associated hemorrhage within the central canal.     

Radiographic morphology of the cranial portion of the cervical vertebral column in Cavalier King Charles Spaniels and its relationship to syringomyelia

OBJECTIVE: To compare radiographic morphology of the atlantoaxial region between Cavalier King Charles Spaniels (CKCSs) and dogs of other breeds and determine whether there was an association between radiographic morphology of the atlantoaxial region and syringomyelia in CKCSs. ANIMALS: 65 CKCSs and 72 dogs of other breeds. PROCEDURES: The amount that the spinous process of the axis overlapped the dorsal arch of the atlas, the relative size of the spinous process of the axis, and the amount of widening of the atlantoaxial joint that occurred when the neck was moved from a neutral to a flexed position were measured on lateral radiographic projections of the atlantoaxial region. Magnetic resonance images were reviewed to identify CKCSs with syringomyelia. RESULTS: The amount of overlap of the atlas and axis and the relative size of the spinous process of the axis were significantly smaller in CKCSs than in dogs of other breeds. However, the amount of widening of the atlantoaxial joint that occurred when the neck was moved from a neutral to a flexed position was not significantly different between groups, and no association was detected between syringomyelia and excessive atlantoaxial joint space widening or between syringomyelia and an excessively small axial spinous process. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that radiographic morphology of the atlantoaxial region in CKCSs differs from morphology of that region in dogs of other breeds, but that these differences do not account for why some CKCSs develop syringomyelia and others do not.     

Ossification of the Atlas-Axis Complex in the Dog*

Skeleton preparations of 200 Beagles of known age, ranging from embryos at 28 days of age to 10 year old adults were studied. Preparations of gross specimens were examined with the aid of Alizarin red staining, binocular dissection and histological sections. Ossification centers for the components of the atlas and axis were identified and followed to their fusion. The developmental ossification sequence for these bones is described and compared with that of other similar studies in other species.     

Vertebral malformation, syringomyelia, and ventricular septal defect in a dromedary camel (Camelius dromedarius).

An occipitoatlantoaxial malformation and ventricular septal defect (VSD) were diagnosed in a 36-hour-old female camel. Physical examination revealed a firm protrusion of the dorsal aspect of the atlas and axis, tilting of the head to the left, and a grade V/VI systolic murmur. Neurological examination revealed proprioceptive deficits and ataxia of all 4 limbs. Radiographic examination and necropsy demonstrated malformation, fusion of the atlas to the occiput and hypoplasia of the dens of the axis, and subluxation of the atlantoaxial joint. Dorsoventral laxity of the atlantoaxial joint was also present, with compression of the cervical spinal cord. A 1.5-cm-diameter VSD was observed also. Histopathologic examination of the cervical spinal cord revealed a cavity extending from the level of the first to fourth cervical segment, dorsal to the central canal, 5 cm long and 1-2 mm in diameter. The cells around the cavity were positive for glial fibrillary acidic protein and sporadically positive for vimentin. This cavitary structure was consistent with syringomyelia, which was lined by glial cells, surrounded by edematous white matter with Wallerian-like degeneration and with neuronal necrosis in the adjacent dorsal horns.