Decompressive surgery for treatment of a dorsal compressive atlantoaxial band causing nonambulatory tetraparesis in three toy-breed dogs

Ji Hyeon Lee 1Department of Veterinary Surgery, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul 05029, Korea.

Search for other papers by Ji Hyeon Lee in
Current site
Google Scholar
PubMed Close
 DVM
,
Hun Young Yoon 1Department of Veterinary Surgery, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul 05029, Korea.

Search for other papers by Hun Young Yoon in
Current site
Google Scholar
PubMed Close
 DVM, PhD
,
Jung Hyun Kim 2Department of Veterinary Internal Medicine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul 05029, Korea.

Search for other papers by Jung Hyun Kim in
Current site
Google Scholar
PubMed Close
 DVM, PhD
, and
Hyun Jung Han 3Department of Veterinary Emergency Medicine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul 05029, Korea.

Search for other papers by Hyun Jung Han in
Current site
Google Scholar
PubMed Close
 DVM, PhD
DOI:
https://doi.org/10.2460/javma.255.6.700
Volume/Issue:
Volume 255: Issue 6
Online Publication Date:
15 Sep 2019
Restricted access
Sign In Reprints and Permissions Purchase Article

Abstract

CASE DESCRIPTION

3 toy-breed dogs (a 5-year-old Pomeranian, a 12-year-old Pomeranian, and a 13-year-old Yorkshire Terrier) were evaluated because of a sudden onset of nonambulatory tetraparesis.

CLINICAL FINDINGS

In all 3 dogs, MRI revealed a dorsal compressive atlantoaxial (AA) band as the cause of the neurologic deficits. Percentages of dorsal compression of the spinal cord were 28.6%, 31%, and 28.8%.

TREATMENT AND OUTCOME

All 3 dogs underwent decompressive surgery via a dorsal approach. The AA band was removed, and a durotomy was performed, which resulted in spontaneous drainage of a copious amount of CSF. Grossly, the spinal cord parenchyma appeared normal, other than the dorsal compression. To alleviate the AA instability resulting from removal of the dorsal AA ligament, 2-0 polydioxanone was placed in the dorsal cervical muscles extending from the atlantooccipital joint to C2. Postoperatively, all 3 dogs regained normal ambulation between 18 and 30 days after surgery. No complications were reported, and clinical signs did not recur during follow-up times ranging from 4 to 19 months.

CLINICAL RELEVANCE

Findings suggested that surgical treatment may be an effective option in managing dogs with a dorsal compressive AA band causing nonambulatory tetraparesis. Notably, all of the dogs had other craniocervical abnormalities, but none of these abnormalities were considered severe enough to have caused tetraparesis.

Abstract

CASE DESCRIPTION

3 toy-breed dogs (a 5-year-old Pomeranian, a 12-year-old Pomeranian, and a 13-year-old Yorkshire Terrier) were evaluated because of a sudden onset of nonambulatory tetraparesis.

CLINICAL FINDINGS

In all 3 dogs, MRI revealed a dorsal compressive atlantoaxial (AA) band as the cause of the neurologic deficits. Percentages of dorsal compression of the spinal cord were 28.6%, 31%, and 28.8%.

TREATMENT AND OUTCOME

All 3 dogs underwent decompressive surgery via a dorsal approach. The AA band was removed, and a durotomy was performed, which resulted in spontaneous drainage of a copious amount of CSF. Grossly, the spinal cord parenchyma appeared normal, other than the dorsal compression. To alleviate the AA instability resulting from removal of the dorsal AA ligament, 2-0 polydioxanone was placed in the dorsal cervical muscles extending from the atlantooccipital joint to C2. Postoperatively, all 3 dogs regained normal ambulation between 18 and 30 days after surgery. No complications were reported, and clinical signs did not recur during follow-up times ranging from 4 to 19 months.

CLINICAL RELEVANCE

Findings suggested that surgical treatment may be an effective option in managing dogs with a dorsal compressive AA band causing nonambulatory tetraparesis. Notably, all of the dogs had other craniocervical abnormalities, but none of these abnormalities were considered severe enough to have caused tetraparesis.

Contributor Notes

Address correspondence to Dr. Han (ab1234@konkuk.ac.kr).
Cover Journal of the American Veterinary Medical Association
Journal of the American Veterinary Medical Association
Publication Date:
15 Sep 2019

  • 1. Cerda-Gonzalez S, Olby NJ, Griffith EH. Dorsal compressive atlantoaxial bands and the craniocervical junction syndrome: association with clinical signs and syringomyelia in mature Cavalier King Charles Spaniels. J Vet Intern Med 2015;29:887–892.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 2. Marino DJ, Loughin CA, Dewey CW, et al. Morphometric features of the craniocervical junction region in dogs with suspected Chiari-like malformation determined by combined use of magnetic resonance imaging and computed tomography. Am J Vet Res 2012;73:105–111.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 3. Sánchez-Masian D, Luján-Feliu-Pascual A, Font C, et al. Dorsal stabilization of atlantoaxial subluxation using non-absorbable sutures in toy breed dogs. Vet Comp Orthop Traumatol 2014;27:62–67.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 4. Nakamura N, Iwasaki Y, Hida K, et al. Dural band pathology in syringomyelia with Chiari type I malformation. Neuropathology 2000;20:38–43.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 5. Cerda-Gonzalez S, Olby NJ, Mccullough S, et al. Morphology of the caudal fossa in Cavalier King Charles Spaniels. Vet Radiol Ultrasound 2009;50:37–46.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 6. Cerda-Gonzalez S, Dewey CW. Congenital diseases of the craniocervical junction in the dog. Vet Clin North Am Small Anim Pract 2010;40:121–141.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 7. Cerda-Gonzalez S, Olby NJ, Griffith EH. Longitudinal study of the relationship among craniocervical morphology, clinical progression, and syringomyelia in a cohort of Cavalier King Charles Spaniels. J Vet Intern Med 2016;30:1090–1098.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 8. Dewey CW, Marino DJ, Loughin CA. Craniocervical junction abnormalities in dogs. N Z Vet J 2013;61:202–211.

  • 9. Josephson A, Greitz D, Klason T, et al. A spinal thecal sac constriction model supports the theory that induced pressure gradients in the cord cause edema and cyst formation. Neurosurgery 2001;48:636–645.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 10. Hida K, Iwasaki Y, Koyanagi I, et al. Surgical indication and results of foramen magnum decompression versus syringo-subarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 1995;37:673–678.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 11. Driver CJ, Volk HA, Rusbridge C, et al. An update on the pathogenesis of syringomyelia secondary to Chiari-like malformations in dogs. Vet J 2013;198:551–559.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 12. Rusbridge C, Jeffery ND. Pathophysiology and treatment of neuropathic pain associated with syringomyelia. Vet J 2008;175:164–172.

  • 13. Skytte D, Schmökel H, Lang Y, et al. Dura fibrosis and adhesions caused by an atlas malformation in two dogs. DVT 2013;6:18–20.

    • Search Google Scholar
    • Export Citation

  • 14. Cerda-Gonzalez S, Dewey CW, Scrivani PV, et al. Imaging features of atlanto-occipital overlapping in dogs. Vet Radiol Ultrasound 2009;50:264–268.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 15. de Lahunta A, Glass E. Small animal spinal cord disease. In: de Lahunta A, Glass E, eds. Veterinary neuroanatomy and clinical neurology. 3rd ed. St Louis: Elsevier Saunders, 2009;243–284.

    • Search Google Scholar
    • Export Citation

  • 16. Rusbridge C. Chiari-like malformation with syringomyelia in the Cavalier King Charles Spaniel: long-term outcome after surgical management. Vet Surg 2007;36:396–405.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 17. Dewey CW, Berg JM, Barone G, et al. Foramen magnum decompression for treatment of caudal occipital malformation syndrome in dogs. J Am Vet Med Assoc 2005;227:1270–1275.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 18. Dewey CW, Marino DJ, Bailey KS, et al. Foramen magnum decompression with cranioplasty for treatment of caudal occipital malformation syndrome in dogs. Vet Surg 2007;36:406–415.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 19. Ortinau N, Shores A, Vitale S, et al. Foramen magnum decompression surgery in 23 Chiari-like malformation patients 2007–2010: outcomes and owner survey results. Can Vet J 2015;56:288–291.

    • Search Google Scholar
    • Export Citation

  • 20. Preul MC, Campbell PK, Garlick DS, et al. Application of a new hydrogel dural sealant that reduces epidural adhesion formation: evaluation in a large animal laminectomy model. J Neurosurg Spine 2010;12:381–390.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement