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Questions and Answers
Which of the following breeds is NOT predisposed to Atlantoaxial Instability?
Neurological dysfunction due to Atlantoaxial Instability can lead to respiratory compromise.
True
What diagnostic technique is considered the choice for identifying Atlantoaxial Instability?
Radiographs
The preferred surgical approach for Atlantoaxial Instability is the ______ approach.
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Match the imaging modalities with the information they provide in diagnosing Atlantoaxial Instability:
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What is the primary stabilization technique used for Atlantoaxial Instability?
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The complication rate for ventral stabilization of Atlantoaxial Instability is higher than dorsal stabilization.
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Name one neurological dysfunction that may result from Atlantoaxial Instability.
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Which clinical signs are associated with caudal brachial plexus avulsions (C8-T2)?
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Immediate surgical intervention for complete avulsions is recommended for Brachial Plexus Trauma.
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What is the diagnostic technique of choice for Brachial Plexus Trauma?
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Chondrodystrophic breeds, such as __________, are predisposed to Cervical Disc Disease.
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Match the type of surgical repair technique with its description:
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What is the prognosis for Brachial Plexus Trauma if radial nerve roots are affected?
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Neurological deficits are equally common with lesions in all cervical segments.
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What are the two potential timings for surgical intervention in Brachial Plexus Trauma?
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Study Notes
Atlantoaxial Instability
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A condition affecting the first two vertebrae (C1 and C2) in the neck, causing instability.
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Clinical Signs:
- Neck pain (up to 60% of patients)
- Neurological dysfunction: Mild gait abnormalities to tetraplegia, leading to respiratory compromise and cardiac arrest.
- Possible intracranial signs due to hydrocephalus, syringomyelia, or basilar artery compromise.
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Predisposed Breeds:
- Toy breeds: Yorkshire Terriers, Chihuahuas, Miniature Poodles, Pomeranians, Pekingese.
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Diagnostic Technique of Choice:
- Radiographs (ideally under sedation or general anesthesia).
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Additional Imaging Modalities:
- CT: Assessing the dens, dens fractures, and implant size selection.
- MRI: Evaluating concurrent spinal cord pathology (edema, syringomyelia, hemorrhage), secondary hydrocephalus, and dens ligaments.
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Preferred Surgical Approach:
- Ventral Approach:
- Allows access to the articular cartilages of C1 and C2, enabling scarification to encourage osseous ankylosis.
- Provides access to the greater trochanter of the humerus for bone graft harvesting.
- Allows for odontoidectomy in cases of a dorsal deviating or un-united dens.
- Ventral Approach:
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Stabilization Techniques:
- Transarticular screws/pins, threaded pins/screws with PMMA, and locking plates.
- Threaded pins with PMMA are most common.
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Complications Associated with Surgical Treatment:
- Dorsal stabilization: High complication rate (up to 71%) with implant failure common within the first 3 weeks.
- Ventral stabilization: Complication rate up to 53%.
- Surgical manipulation can cause repetitive contusive or compressive spinal cord damage.
- Ventral approach: Respiratory compromise (laryngeal paralysis, tracheal compression from PMMA/implants, damage to the respiratory nucleus in the brainstem, aspiration pneumonia), and fractures of C1 and C2 are possible.
Brachial Plexus Trauma
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Injury to the brachial plexus (group of nerves in the neck and shoulder that control movement and sensation in the front limb).
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Clinical Signs:
- Peracute onset following trauma or a pet going missing.
- Signs vary depending on the affected spinal nerve roots.
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Specific Clinical Signs with Different Avulsion Types:
- Cranial avulsions (C5-C7):
- Rare, few clinical signs.
- Animals can bear weight.
- Muscle atrophy of the supraspinatus and infraspinatus.
- Caudal avulsions (C8-T2):
- More common.
- Affect radial nerve function.
- Limb often carried in a flexed position.
- Horner's syndrome is common due to damage to the T1 segment.
- Complete avulsions: - Most severe. - Loss of sensation over the entire limb. - Shoulder held lower than the contralateral limb. - Marked muscle atrophy after a week.
- Cranial avulsions (C5-C7):
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Diagnostic Technique of Choice:
- MRI: Visualizes complete and partial avulsions, guiding immediate or delayed repair decisions.
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Surgery Indication:
- Immediate intervention for complete avulsions.
- Delayed surgery (3-6 months) for potential nerve repair, carrying risks of nerve contraction, fibrosis, and muscle denervation.
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Surgical Repair Techniques:
- Direct end-to-end anastomosis: Direct suturing of the nerves (older technique).
- Graft repair: More common, using a graft as a conduit for nerve repair.
- Neurotization: Nerve transfer (repair of choice in human surgery), but may be less effective for brachial plexus injuries.
- Reimplantation: Reimplantation of nerve roots onto the spinal cord.
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Prognosis:
- Prognosis for full return of function is generally poor if radial nerve roots are affected.
Cervical Disc Disease
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Condition affecting the intervertebral discs in the neck, leading to nerve compression and neurological deficits.
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Clinical Signs:
- Acute onset in 50% of cases, chronic onset in the other 50%.
- Neck pain is the most consistent sign, especially with cranial cervical lesions.
- Nerve root signature: Affect a single front limb or all four limbs, with tetraparesis more common than tetraplegia.
- Neurological deficits more common with lesions in C4-C7 segments.
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Predisposed Breeds:
- Chondrodystrophic breeds (Dachshunds).
- Also seen in Labradors, Dalmatians, and Dobermans.
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Description
This quiz focuses on atlantoaxial instability, a condition affecting the cervical vertebrae in certain dog breeds. It covers clinical signs, diagnostic techniques, and preferred surgical approaches. Ideal for veterinary students and professionals to test their understanding of this critical condition.
