title: Reduction and fixation of cranial cervical fracture/luxations using screws and polymethylmethacrylate (PMMA) cement: a distraction technique applied to the base of the skull in thirteen dogs.
abstract: OBJECTIVE
  To (1) describe a surgical distraction technique for C1-2 cervical fractures/luxations or atlantoaxial (AA) subluxations using the base of the skull (basion of the foramen magnum) and either C2-3 or C3-4 for the purchase points of intraoperative axial distraction and (2) report outcome in 13 dogs.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Dogs (n = 13).
  
  
  METHODS
  Medical records (September 1995-December 2005) of dogs with fracture/luxation of the cervical spine, or AA subluxations, were reviewed. Only dogs that had intraoperative linear distraction using the base of the skull as a purchase point for a self-retaining retractor were included. Signalment, presenting neurologic deficits, fracture location, and concurrent injury were recorded. Both short-term in-hospital follow-up, including healing and any complications, and long-term telephone follow-up were obtained.
  
  
  RESULTS
  Realignment of the spinal vertebrae, reestablishing the normal properties of the spinal canal, was achieved after distraction in all dogs. Screws and small pins incorporated into polymethylmethacrylate cement were used to span the fracture ventrally and achieve rigid internal fixation. Eight dogs had a complete neurologic recovery, 2 dogs had slight residual ataxia, 2 dogs died, and 1 dog was lost to follow-up. Healing was good (mean, 7.5 weeks) or excellent (mean, 5.1 months) based on in-hospital follow-up (mean, 5.1 months). On final telephone follow-up (mean, 7.7 years), no dogs were reported to have had any associated problems or additional surgery.
  
  
  CONCLUSIONS
  This surgical distraction technique was a reliable, relatively simple method to obtain reduction of fracture/luxations of C1-2 to re-align the spinal canal. Mortality in this series appears lower than that previously reported and supports surgical management of these injuries.
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, USA.
authors.forename: Fred S
authors.initials: FS
authors.lastname: Pike
authors.forename: M S A
authors.initials: MS
authors.lastname: Kumar
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Boudrieau
mesh_terms: D000818:Animals; D001843:Bone Cements; D001863:Bone Screws / Q000662:veterinary*; D002574:Cervical Vertebrae / Q000473:pathology*; D004285:Dogs; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000662:veterinary*; D050723:Fractures, Bone / Q000601:surgery / Q000662:veterinary*; D004204:Joint Dislocations / Q000601:surgery / Q000662:veterinary*; D008297:Male; D019904:Polymethyl Methacrylate; D012189:Retrospective Studies; D019291:Skull Base; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate