Luxação traumática da articulação atlanto-occipital em cão / Traumatic atlanto-occipital luxation in a dog

No presente trabalho objetivou-se descrever um caso de luxação atlanto-occipital em um canino, apresentando tetraparesia grave e dor cervical após acidente auto- mobilístico. Diante dos dados da anamnese e dos achados do exame clínico geral e neurológico, suspeitou-se de uma lesão neurológica traumática, que possivelmente teria atingindo a medula espinhal cervical e/ou o tronco encefálico. Após solicitação de exame radiográfico foi constatada luxação unilateral da articulação atlanto- -occipital direita. Diante da ausência de resposta ao tratamento clínico optou-se pela redução cirúrgica aberta e estabilização interna da articulação. Entretanto, no pós-operatório, imediatamente, o animal apresentou quadro dispneico e cianótico, quando foram instituídas a fluidoterapia e oxigênio-terapia. Apesar de todos os esforços empregados, o animal foi a óbito após 2 dias da ocorrência da cirurgia.

The present article aims to describe a case of an atlanto-occipital luxation in a canine, showing severe tetraparesis and cervical pain after an automobilist accident. Given the data obtained in the anamnesis and his findings of the clinical and neurological exam, a traumatic neurological injury was suspected, which would possibly reach the cervical spinal cord and/or brainstem. After requesting the radiographic examination, unilateral luxation of the right atlantooccipital joint was found. Facing the absence of response to the clinical treatment, the open surgical reduction and internal joint stabilization was chosen. However, postoperatively immediately, the animal presented a dyspneic and cyanotic panorama when they were imposed with fluid and oxygen therapy. Despite every effort, the animal died two days after the occurrence of surgery.

[Surgical treatment of craniocervical instability. Review paper]. / Tratamiento quirúrgico para la inestabilidad craneocervical. Trabajo de revisión.

The concept of spinal instability is still controversial. Anatomical, biomechanical, clinical and radiographic variants are involved and make the definition complicated. There are solid diagnostic bases in cases of fractures and degenerative disorders; however, pure spinal instability is still under study. The latter may be defined as increased mobility that goes beyond the physiological limits of one vertebra over another in at least one of the three spinal planes of motion. In the case of the craniocervical region, its understanding becomes even more challenging, since its anatomy and physiology are more complex and it is more mobile. Surgical treatment is possible with either an anterior or a posterior approach. Best results are obtained with occipitocervical or atlantoaxial stabilization through a posterior approach, since the anterior one has its limitations. For example, a transoral approach with a bone graft provides compression strength but does not enable immediate appropriate fixation and involves the risk of infection. The choice of the surgical approach must consider the patient's medical status, the specific spine levels involved, the extent of neurological compromise, the X-ray abnormalities and the individual pathology. The goals of surgery are achieved through an appropriate anatomical alignment, assuring the protection of the neural elements and achieving proper spine stabilization with as much preservation of the mobile vertebral segments as possible.

Dislocaciones occipito-atloideas: revisión de la literatura y presentación de 7 casos / Atlanto-occipital dislocations: literature review and report of 7 cases

Esta lesión poco común, se presenta con gran frecuencia como muerte súbita, por lo que su diagnóstico muchas veces se realiza posmortem. Gracias al desarrollo de las técnicas de resucitación y reanimación en los centros especializados en politrauma, han sobrevivido algunos pacientes con dislocación occipito-atloidea, tema de este trabajo. Se presentan 7 casos atendidos en el Servicio de Neurocirugía del Hospital Universitario General Calixto García(AU)

This uncommon injury is frequently presented as sudden death. That`s why its diagnosis is many times made after death. Thanks to the development of resuscitation and reanimation techniques in the centers specialized in polytrauma, some patients with atlanto-occipital dislocation have survived, and this is the topic we deal with in this paper. 7 cases that received attention at the Neurosurgery Service of General Calixto García Teaching Hospital are presented here(AU)