ATLANTOAXIAL SUBLUXATION (hypoplasia of the dens)

by Leanne Bertani
This is not a common disorder, bt !hen it does occr, it can be a "ery difficlt e#perience for the do$,
o!ner and breeder%
defnition
Atlantoa#ial Sbl#ation is an instability of the first and second "ertebrae in
the nec&% It ta&es its name from the proper name of the first cer"ical
"ertebrae (the atlas) and the second "ertebrae (the a#is)% The lac& of stability
cases compression of the spinal cord that reslts in pain or paralysis%
cause
This condition can be cased by trama in any do$, bt is more often seen as
either a con$enital or de"elopmental malformation in small breeds% It has
e"en been called 'na"oidable( in small breeds by some "eterinary athors%
Other athors belie"e it is most li&ely related to a $enetic "asclar
insfficiency that allo!s at least part of the dens to be reabsorbed%
symptoms
)ost affected do$s e#hibit symptoms prior to a year of a$e, altho$h those
!ith problems de to in*ry may be older% The first symptom is nec& pain,
made !orse by fle#ion of the nec&% It may be noticed that the +hin is
relctant to lo!er its head to the food bo!l, or the +hin may let ot sdden
'yips( of pain, follo!ed by tremblin$% ,ependin$ on the de$ree of spinal
cord compression, other symptoms can inclde clmsiness or e"en paralysis
and death% ,ia$nosis is $enerally made by #ray%
details
To nderstand this instability, thin& of the first "ertebrae (the atlas) as a rin$
in a rin$-toss $ame% Then thin& of the second "ertebrae as the platform and
the post% The rin$ of the first "ertebrae fits o"er the little post of the second
"ertebrae, and is held in place by a li$ament% Bt if the little post (called the
'dens( or 'odontoid process() is bro&en or malformed, the rin$ !on.t stay
properly on the base% In*ry or la#ity of the li$ament may also allo! eno$h
mo"ement of the "ertebrae to tramati/e the spinal cord% The dens forms at
abot the a$e of 0-12 !ee&s in a pp, and fses to the a#is at abot 3-0
months of a$e% 4or this reason, if there are $oin$ to be symptoms de to an
abnormality of the dens, they !ill sally become noticed prior to a year of
a$e% Ob"iosly, the dens is smaller and more fra$ile in toy do$s than it is in
lar$e do$s, so it is more easily malformed or bro&en%
treatment
Treatment is dependent on the se"erity of symptoms% If symptoms are mild,
sometimes small do$s can be treated conser"ati"ely (non-sr$ically) !ith
anti-inflammatories, crate rest (for se"eral !ee&s), and possibly a nec&
brace, in order to allo! time for fibros tisse to form and stabili/e the
"ertebrae% ,o$s !ith more se"ere symptoms re5ire sr$ical stabili/ation of
the t!o "ertebrae !ith !ire, stre, pins, or bone $rafts% ,o$s !ith this
condition mst be handled !ith care ntil the condition is corrected% A
sdden ma*or dislocation of the "ertebrae can case paralysis or death%
prognosis
%Small do$s are more li&ely to respond to conser"ati"e treatment than lar$e
do$s, bt do$s that are treated conser"ati"ely are more li&ely to ha"e a
recrrence of the problem than do$s that are treated sr$ically% 6"en
sr$ical treatment is not fool-proof% In a stdy of 17 do$s that nder!ent the
sr$ery for se"ere symptoms, t!o of them died and t!o re5ired an
additional sr$ery%