Surgical Treatment of Atlantoaxial Instability Using 3D-Printed Drill Guides, Pedicle Screw Placement, and a 3D-Printed Plate

Case Report: Atlantoaxial instability (AAI) is most common in small breed dogs. Recently, patient-specific 3D-printing technology has been used to fabricate patient-specific drill guides to place bicortical vertebral screws joined with polymethylmethacrylate and patient-specific bone plates applied with a combination of ventral C1 vertebral arch and C2 vertebral body screws. These procedures were reported with major complication rates as high as 33%. The purpose of our case report is to describe the use and outcome of patient-specific 3D-printed drill guides and a bone plate applied with pedicle screw placement during an AAI ventral stabilization procedure. A 1.5-year-old female spayed Dachshund presented with cervical pain refractory to medical management. Physical and advanced imaging examinations contributed to a diagnosis of AAI, and the dog underwent surgical ventral stabilization of the atlantoaxial joint. Patient-specific, 3D-printed drill guide templates were used to direct placement of 2.0 mm (C1) and 1.5 mm (C2) screws into the vertebral pedicles to secure a patient-specific, 3D-printed bone plate for stabilization C1–C2. The dog showed no recurrence of previous clinical signs or radiographic screw loosening at final recheck (122 days). This case demonstrates an effective use of patient-specific, 3D-printed drill guides and a bone plate to place pedicle screws in an AAI stabilization procedure. Our case did not show any complications associated with previously described fixation techniques. This may be due to the increased stability provided by the pedicles of C1 compared to the ventral vertebral arch used for fixation previously. This method should be considered in AAI cases.

Acknowledgements: There was no financial support for this project. Dr. Oxley is the director of Vet3D, the company that fabricated the guide system and designed the bone plate used in this case.

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Artikel online veröffentlicht:
11. September 2023