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The spine

image of The spine
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Abstract

Traumatic injuries involving the vertebral column and spinal cord are relatively common in small animal practice. This chapter deals with evaluation of the patient, management of the spinal trauma patient, general comments on postoperative management; prognosis. Atlantoaxial subluxation; Cervical fractures and luxations;Thoracic fractures and luxations; Thoracolumbar fractures and luxations; Caudal thoracic fractures and luxations; lumbar fractures and luxations; Seventh lumbar vertebra fractures; Sacral fractures and caudal vertebral fractures.

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Figures

Image of 18.2
18.2 Radiograph of a cat that sustained multiple vertebral and pelvic injuries including luxation of L4–L5 and L7–S1. Note the concomitant bilateral ilial wing fractures and left ischial fracture. A left sacral fracture is also present.
Image of 18.3
18.3 (a) Neutral and (b) stressed radiographs demonstrating vertebral instability at T11–T12 with ventral displacement of the caudal vertebrae evident on the mildly flexed projection (arrowed). Narrowing of the T11–T12 intervertebral disc was noted on the neutral radiograph; however, the subluxation was not apparent.
Image of 18.4
18.4 (a) Lateral and (b) ventrodorsal radiographs and (c) lateral and (d) ventrodorsal reconstructed CT images of a dog with an L5 fracture. These images demonstrate the superiority of CT multiplanar reformatted images compared to conventional radiography. Identification of the comminuted nature of the L5 vertebral fracture with CT aided surgical planning.
Image of 18.5
18.5 Transverse CT images showing (a) C6 and (b) C7 in a dog with a C6–C7 vertebral luxation. Note the rotational malalignment of the two vertebrae with each rotated in opposite directions. The white line indicates the sagittal plane of the vertebra; in a normal dog these should be parallel to each other. Failure to recognize this feature could result in malpositioning of implants and life-threatening spinal cord injury.
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18.6 Dorsal and ventral compartment structures of the vertebral column. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.7 A C3 fracture with concomitant luxation of the C3–C4 facets in a Lurcher. This is a combined dorsal and ventral compartment injury that has resulted in gross vertebral instability.
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18.8 A C2–C3 luxation in a Weimaraner. The intact vertebral bodies are providing a ventral buttress and contributing to vertebral stability (compare with Figure 18.7 ).
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18.9 A Mason metasplint provided temporary vertebral stabilization in this Chihuahua with a mid-thoracic fracture–luxation.
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18.10 (a) Lumbar fracture–luxation in an immature Labrador Retriever with mild paraparesis which was managed by cage confinement. (b) By 10 weeks post-trauma the fracture had healed and the neurological deficits had resolved.
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18.11 (a) Implantation angles in canine vertebrae: (b) C4 and (c) L3. The angle (star) is defined as that between the sagittal plane of the vertebra and the implantation corridor. Note that cervical vertebrae are approached ventrally, and thoracolumbar vertebrae dorsolaterally. (Modified from )
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18.12 Ventral surgical approach to C1–C2. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.13 (a) Exposure and fixation of the atlantoaxial articulation. (b) Schematic views of the atlas and axis to show the ideal position of fixation screws in the pedicles of C1 and the caudal aspect of the C2 vertebral body. (c) Preoperative and (d) postoperative lateral radiographs showing repair of a traumatic atlantoaxial subluxation in a Dachshund using screws and cement. Note the C2–C3 block vertebra. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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18.14 Ventral exposure of the cervical spine. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.15 (a) Lateral preoperative radiograph and (b–c) postoperative semitransparent volume rendered hardware reconstructed CT images of a C2 fracture in a Labrador Retriever that was stabilized with screws and cement.
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18.16 (a–b) Schematic views of the cervical vertebrae to show the ideal positioning of vertebral body pins and bone cement. (c) A C4–C5 luxation in a 6-month-old Dobermann. (d) Lateral and (e) ventrodorsal postoperative radiographs of the case shown in (c). Fixation was achieved using vertebral body positive-profile threaded pins and bone cement. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.17 Exposure of the dorsal thoracic spine. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.18 (a) Schematic view of the thoracic spine to show the ideal position of plastic spinal plates. (b) Thoracic vertebral luxation in a Labrador Retriever. Note the intact ventral buttress. (c) Lateral and (d) ventrodorsal postoperative radiographs. Vertebral reduction and stabilization were achieved using orthopaedic wire secured to the dorsal spinous processes of the adjacent vertebrae. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.19 (a–b) Schematic views of the lumbar spine to show the ideal position of a vertebral body plate and screws. (c) Lateral and (d) ventrodorsal preoperative and (e) lateral and (f) ventrodorsal postoperative radiographs demonstrating stabilization of an L1–L2 luxation in a Springer Spaniel using a vertebral body bone plate and screws. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.20 Dorsal exposure of the lumbar spine. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.21 (a–b) Schematic views of the lumbar spine to show the ideal position of vertebral body pins and bone cement. Lateral (c) preoperative and (d) postoperative radiographs demonstrating stabilization of a T10–T11 fracture–luxation in an Irish Setter using screws and cement. This dog had retained deep pain perception caudal to the lesion despite the severity of vertebral displacement in this region of the spine. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.22 Dorsal exposure of the lumbosacral spine. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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18.23 (a) Preoperative surface shaded volume rendered reconstructed CT image and (b) lateral and (c) ventrodorsal postoperative radiographs showing stabilization of an L7 vertebral fracture in a Springer Spaniel using screws and cement. Screws have been placed across the lumbosacral facets, the L7 screws have been bent caudomedially and all have been incorporated into the bone cement.
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18.24 Classification of sacral fractures. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. (Redrawn after )
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18.25 (a) Ventrodorsal preoperative and (b) lateral and (c) ventrodorsal postoperative radiographs demonstrating stabilization of bilateral sagittal sacral fractures in a Rottweiler. Fracture reduction was achieved by realigning and stabilizing the L7–S1 facets with transarticular screws. The fractures were then bridged by placing screws in L7 and the ilial bodies and connecting them with bone cement. The left ischial fracture was managed non-surgically.

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