Fractures of the Second Cervical Vertebra in 66 Dogs and 3 Cats: A Retrospective StudyFunding No funding was received for the present study.
04 November 2018
27 December 2018
17 May 2019 (online)
Background In human medicine, fractures of the second cervical vertebra have been studied elaborately and categorized in detail. This is not the case in veterinary medicine where clinical decisions are often based on old studies focusing on the cervical spine in general.
Objectives The aim of this study was to describe the clinical features, fracture types, therapeutic options and outcome of dogs and cats with a fractured axis.
Study Design The present study was a multi-institutional retrospective case series.
Results Crossbreeds and Labrador Retrievers were the most represented dog breeds. Median age was 2 years. Motor vehicle accident was the most common inciting cause, followed by frontal collision. The most common neurological deficits ranged from cervical pain with or without mild ataxia (22/68) to tetraparesis (28/68) and tetraplegia (11/68). Concerning treatment, 37 of 69 patients underwent surgical fracture stabilization, 27/69 received conservative therapy and 5/69 were immediately euthanatized. Of all treated cases, 52/58 showed ambulatory recovery (23/25 of the conservatively treated and 29/33 of the surgically treated cases), whereby in 40/52 cases full recovery without persisting signs was achieved.
Conclusions Fractures of the axis commonly occur in young dogs. In many cases, neurological deficits are relatively mild. Generally, animals with a fractured axis have a very good prognosis for functional recovery. The risk of perioperative mortality is considerably lower than previously reported.
All authors drafted, revised and approved the submitted manuscript. Beatriz Vidondo contributed to data analysis and interpretation. Takeshi Aikawa, Randy J. Boudrieau, Stefan Rupp, Aurelien Jeandel, Nicholas Jeffery, Konrad Jurina, and Pierre Moissonnier contributed to acquisition of data and data analysis and interpretation. Fenella E. Schmidli contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Veronika M. Stein contributed to study design and data analysis and interpretation.
- 1 Jeffery ND. Vertebral fracture and luxation in small animals. Vet Clin North Am Small Anim Pract 2010; 40 (05) 809-828
- 2 Bali MS, Lang J, Jaggy A, Spreng D, Doherr MG, Forterre F. Comparative study of vertebral fractures and luxations in dogs and cats. Vet Comp Orthop Traumatol 2009; 22 (01) 47-53
- 3 Selcer RR, Bubb WJ, Walker TL. Management of vertebral column fractures in dogs and cats: 211 cases (1977-1985). J Am Vet Med Assoc 1991; 198 (11) 1965-1968
- 4 Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine 1997; 22 (16) 1843-1852
- 5 Hadley MN, Dickman CA, Browner CM, Sonntag VK. Acute axis fractures: a review of 229 cases. J Neurosurg 1989; 71 (5 Pt 1): 642-647
- 6 Hadley MN, Browner C, Sonntag VK. Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 1985; 17 (02) 281-290
- 7 Hawthorne JC, Blevins WE, Wallace LJ, Glickman N, Waters DJ. Cervical vertebral fractures in 56 dogs: a retrospective study. J Am Anim Hosp Assoc 1999; 35 (02) 135-146
- 8 Bruecker KA. Principles of vertebral fracture management. Semin Vet Med Surg (Small Anim) 1996; 11 (04) 259-272
- 9 Kinns J, Mai W, Seiler G. , et al. Radiographic sensitivity and negative predictive value for acute canine spinal trauma. Vet Radiol Ultrasound 2006; 47 (06) 563-570
- 10 Kepler CK, Vaccaro AR, Fleischman AN. , et al. Treatment of axis body fractures: a systematic review. Clin Spine Surg 2017; 30 (10) 442-456
- 11 Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa M. Fractures of the C-2 vertebral body. J Neurosurg 1994; 81 (02) 206-212
- 12 Burke JT, Harris Jr JH. Acute injuries of the axis vertebra. Skeletal Radiol 1989; 18 (05) 335-346
- 13 Hadley MN, Walters BC, Grabb PA. , et al. Isolated fractures of the axis in adults. Neurosurgery 2002; 50 (3, Suppl): S125-S139
- 14 Pryputniewicz DM, Hadley MN. Axis fractures. Neurosurgery 2010; 66 (3, Suppl): 68-82
- 15 Greenberg MS. Handbook of Neurosurgery. 5th ed. Lakeland, FL: Thieme Medical Publishers; 2001: 704-706
- 16 Anderson LD, D'Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974; 56 (08) 1663-1674
- 17 Fujimura Y, Nishi Y, Kobayashi K. Classification and treatment of axis body fractures. J Orthop Trauma 1996; 10 (08) 536-540
- 18 Korres DS, Zoubos AB, Kavadias K, Babis GC, Balalis K. The “tear drop” (or avulsed) fracture of the anterior inferior angle of the axis. Eur Spine J 1994; 3 (03) 151-154
- 19 Korres DS, Papagelopoulos PJ, Mavrogenis AF. , et al. Multiple fractures of the axis. Orthopedics 2004; 27 (10) 1096-1099
- 20 Dunn ME, Seljeskog EL. Experience in the management of odontoid process injuries: an analysis of 128 cases. Neurosurgery 1986; 18 (03) 306-310
- 21 Falavigna A, Righesso O, da Silva PG. , et al. Management of type ii odontoid fractures: experience from Latin American spine centers. World Neurosurg 2017; 98: 673-681
- 22 Nourbakhsh A, Shi R, Vannemreddy P, Nanda A. Operative versus nonoperative management of acute odontoid type II fractures: a meta-analysis. J Neurosurg Spine 2009; 11 (06) 651-658
- 23 Butler JS, Dolan RT, Burbridge M. , et al. The long-term functional outcome of type II odontoid fractures managed non-operatively. Eur Spine J 2010; 19 (10) 1635-1642
- 24 Stone EA, Betts CW, Chambers JN. Cervical fractures in the dog - literature and case review. J Am Anim Hosp Assoc 1979; 15 (04) 463-471
- 25 Takahashi F, Hakozaki T, Kanno N, Harada Y, Yamaguchi S, Hara Y. Evaluation of the dens-to-axis length ratio and dens angle in toy-breed dogs with and without atlantoaxial instability and in healthy Beagles. Am J Vet Res 2017; 78 (12) 1400-1405
- 26 Scott EW, Haid Jr RW, Peace D. Type I fractures of the odontoid process: implications for atlanto-occipital instability. Case report. J Neurosurg 1990; 72 (03) 488-492
- 27 Forterre F, Precht C, Riedinger B, Bürki A. Biomechanical properties of the atlantoaxial joint with naturally-occurring instability in a toy breed dog. A comparative descriptive cadaveric study. Vet Comp Orthop Traumatol 2015; 28 (05) 355-358
- 28 Reber K, Bürki A, Vizcaino Reves N. , et al. Biomechanical evaluation of the stabilizing function of the atlantoaxial ligaments under shear loading: a canine cadaveric study. Vet Surg 2013; 42 (08) 918-923
- 29 Clark CR, White III AA. Fractures of the dens. A multicenter study. J Bone Joint Surg Am 1985; 67 (09) 1340-1348
- 30 German JW, Hart BL, Benzel EC. Nonoperative management of vertical C2 body fractures. Neurosurgery 2005; 56 (03) 516-521 , discussion 516–521
- 31 Gendreau CL, Cawley AJ. Case report. Repair of fractures of the axis. Can Vet J 1969; 10 (11) 297-301
- 32 Trotter EJ. Cervical spine locking plate fixation for treatment of cervical spondylotic myelopathy in large breed dogs. Vet Surg 2009; 38 (06) 705-718