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Case Reports
. 2014 Nov;55(11):1069-73.

Atlanto-axial approach for cervical myelography in a Thoroughbred horse with complete fusion of the atlanto-occipital bones

Monica Aleman  1 , Abigail N Dimock  1 , Erik R Wisner  1 , Jamie W Prutton  1 , John E Madigan  1
Affiliations
Case Reports

Atlanto-axial approach for cervical myelography in a Thoroughbred horse with complete fusion of the atlanto-occipital bones

Monica Aleman et al. Can Vet J. 2014 Nov.

Abstract
in English, French

A 2-year-old Thoroughbred gelding with clinical signs localized to the first 6 spinal cord segments (C1 to C6) had complete fusion of the atlanto-occipital bones which precluded performing a routine myelogram. An ultrasound-assisted myelogram at the intervertebral space between the atlas and axis was successfully done and identified a marked extradural compressive myelopathy at the level of the atlas and axis, and axis and third cervical vertebrae.

Approche atlanto-axiale pour une myélographie cervicale chez un cheval Thoroughbred avec la fusion complète des os occipito-atloïdiens. Un hongre Thoroughbred âgé de 2 ans avec des signes cliniques localisés aux 6 premiers segments de la colonne vertébrale (C1 à C6) avait une fusion complète des os occipito-atloïdiens qui empêchait la réalisation d’un myélogramme de routine. Un myélogramme par échographie à l’espace intervertébral entre l’atlas et l’axis a été réalisé avec succès et a identifié une myélopathie extradurale compressive prononcée au niveau de l’atlas et de l’axis ainsi que de l’axis et de la troisième vertèbre cervicale.(Traduit par Isabelle Vallières).

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Figures

Figure 1
Figure 1
Survey radiographs of occipital condyles and atlas. Normal horse, lateral view; note the normal atlanto-occipital articulation delineated by black arrows, occipital bone (O), occipital condyle (OC), arch of atlas (C1), spinous process of axis (C2), and dens (D) (1A). Current case; note no obvious atlanto-occipital articulation, unidentifiable occipital condyles, blunted cranial aspect of the spinous process of the axis (single black arrow), and dorsal deviation of the third cervical vertebra (C3) with collapse of the intervertebral disc ventrally (double black arrows) (1B). The spinal needle is pointing to the area of the attempted atlanto-occipital cisternal centesis.
Figure 2
Figure 2
Sonographic anatomy for cerebrospinal fluid centesis between the atlas and axis. Longitudinal ultrasound view of the atlas (C1) and axis (C2) cervical vertebrae. Note subarachnoid space (SAS) depicted by white small key symbol, spinal cord (SC) indicated by white large key symbol; needle placement not shown.
Figure 3
Figure 3
Myelogram showing subarachnoid contrast distribution. Myelogram in lateral position with limited extension of the neck. Note abrupt interruption of contrast columns at the level of the atlas vertebral body (dorsal and ventral shown by first 2 white arrows on the left), and marked attenuation of the dorsal contrast column at the level of the atlas and axis [third white arrow (right of image)].
Figure 4
Figure 4
Computed tomographic (CT) myelogram. Three-dimensional reformatted CT image of the axial-atlanto-occipital region. Note the absence of atlanto-occipital space (white arrow). O = occipital bone, C1 = atlas, C2 = axis (4A). Transverse CT myelogram at the level of the axis and third cervical vertebra showing lateral impingement of the spinal cord (note attenuation of contrast column on left side) (4B). Note the maintenance of the contrast column dorsally at this level. Dorsal is top, ventral is bottom, right (R) and left (L) sides are shown. C2 = axis, C3 = third cervical vertebra, C2–C3 = C2–C3 articulation, Epi = epidural space, SC = spinal cord, * = subarachnoid space highlighted by contrast material.
See this image and copyright information in PMC

References

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