Cervical vertebral Fusion in case of C5-C6 vertebral fracture in a dog

History

  1. A 6 years old dog was presented to our clinic in Cairo (DrPaws Veterinary Hospital) with sudden tetraparesis after a car accident.

Neurological Examination:

  • Hyperreflexia or Exaggerated hind limbs reflexes (Patellar, cranial tibial reflex, sciatic reflex) & Fore limbs reflexes (Extensor carpi reflex ECR, triceps, Biceps)
  • Normal withdrawal reflex of both hind limbs and fore limbs (+21).
  • Normal deep pain sensation (+2)
  • UMN deficits of both fore legs and hind limbs

Localization of neurological deficits

  • UMN deficits of four limbs (C1-C5)

Radiographic examination: C5-C6 vertebral fracture

Recommendations

  • MRI and C.T were performed to evaluate the condition of the spinal cord and severity of injury. C.T was performed to evaluate for preoperative planning of the vertebral fusion.
  • Surgical vertebral fusion through a ventral neck approach was recommended

CT & MRI reports shows

  • With MRI, most of the spinal cord was kept without transection
  • With CT, C5-C6 fracture with fragmentation of the cranial distal part of the C6 and telescoping through the ventral C5 buttress.

Surgical procedures

  • Ventral neck approach was the approach of choice for cervical lesions

Precautions and vital structures during dissection are;

  1. Muscular reflection of brachycephalic muscle, sternocephalic muscle and sternothyrohyoid muscles.
  2. Trachea, esophagus, recurrent laryngeal nerve, carotid sheath are the main vital structures that should be carefully reflected.
  • Vertebral fusion was performed by 4 screws and connecting cerclage wire. Additional bone cement (PMMA) was placed to fix the overall implant.
  • CT is crucial for preoperative surgical planning including measuring of screws lengths, entry points, dimensions of the fractured vertebrae.

Postoperative Care;

  • Air mattress to decrease occurrence of skin decubitus & Ulcers.
  • Wound Care
  • Neck brace for 3 weeks
  • Physiotherapy & Hydrotherapy

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