Abstract
Atlantoaxial instability (AAI) predominantly affects toy and miniature breed dogs, causing spinal cord compression and variable neurological deficits. This study aims to report a case of ventral stabilization of C1–C2 with additional fixation of C3 using screws and polymethylmethacrylate (PMMA) in a 5-month-old, 0.8 kg female Yorkshire Terrier with AAI. The patient presented with non-ambulatory tetraparesis after mild cervical trauma. Neurological examination revealed signs consistent with C1–C5 myelopathy and cervical pain. Radiographs and computed tomography of the cervical spine indicated dorsal displacement of C2 and severe spinal cord compression, confirming the diagnosis. After failure of conservative treatment, ventral stabilization was performed using 8 locked screws distributed between C1 and C3, combined with PMMA. Progressive clinical improvement was observed, with return to ambulation within 7 days and excellent neurological recovery at 165 days, with no complications during 12 months of follow-up. The stabilization technique using multiple screws and PMMA proved effective and safe in this case, enabling excellent neurological recovery even in the presence of severe neurological deficits. The inclusion of C3 in the stabilization process may have provided greater biomechanical resistance and reduced the risk of implant-related complications, representing a potentially relevant surgical approach in very small-sized patients.
References
Aikawa, T., Shibata, M., & Fujita, H. (2013). Modified ventral stabilization using positively threaded profile pins and polymethylmethacrylate for atlantoaxial instability in 49 dogs. Veterinary Surgery, 42(6), 683-692. https://doi.org/10.1111/j.1532-950X.2013.12016.x. PMid:23662667.
Barillaro, G., Tabbì, M., Minniti, S., Iannelli, N. M., Macrì, F., & Interlandi, C. (2025). Treatment of canine atlantoaxial subluxation with a modified cervical distraction-stabilization technique and clinical outcomes. Animals (Basel), 15(5), 716. https://doi.org/10.3390/ani15050716. PMid:40075999.
Beaver, D. P., Ellison, G. W., Lewis, D. D., Goring, R. L., Kubilis, P. S., & Barchard, C. (2000). Risk factors affecting the outcome of surgery for atlantoaxial subluxation in dogs: 46 cases (1978-1998). Journal of the American Veterinary Medical Association, 216(7), 1104-1109. https://doi.org/10.2460/javma.2000.216.1104. PMid:10754672.
Cabreira, A., Dias da Silva, M. H., Bregalioli, T., & Covino Diamante, G. A. (2024). Atlantoaxial subluxation in an adult bitch - diagnostic and treatment by ventral surgical stabilization. Acta Scientiae Veterinariae, 52, Suppl 1, 964. https://doi.org/10.22456/1679-9216.137936.
De Lahunta, A., Glass, E., & Kent, M. (2021). Small Animal spinal cord disease. In A. De Lahunta, E. Glass & M. Kent (Eds), De Lahunta’s Veterinary Neuroanatomy and Clinical Neurology (5th ed., pp. 292-294). Elsevier. https://doi.org/10.1016/B978-0-323-69611-1.00010-4.
Ferreira, D. R. C., Dias, L. G. G. G., Minto, B. W., Rocha, T. A. S. S., Malta, C. A. D. S., Conceição, M. E. B. A. M. D., & Lucena, D. V. F. (2023). Biomechanical evaluation of four surgical techniques for ventral stabilization of the atlantoaxial joint in dogs. Acta Cirurgica Brasileira, 38, e383223. https://doi.org/10.1590/acb383223. PMid:37729349.
Havig, M. E., Cornell, K. K., Hawthorne, J. C., McDonnell, J. J., & Selcer, B. A. (2005). Evaluation of nonsurgical treatment of atlantoaxial subluxation in dogs: 19 cases (1992-2001). Journal of the American Veterinary Medical Association, 227(2), 257-262. https://doi.org/10.2460/javma.2005.227.257. PMid:16047663.
Platt, S. R., & Da Costa, R. C. (2018). Cervical vertebral column and spinal cord. In S. A. Johnston & K. M. Tobias (Eds.), Veterinary Surgery: Small Animal (2nd ed., pp. 1342-1363). Elsevier.
Platt, S. R., Chambers, J. N., & Cross, A. (2004). A modified ventral fixation for surgical management of atlantoaxial subluxation in 19 dogs. Veterinary Surgery, 33(4), 349-354. https://doi.org/10.1111/j.1532-950X.2004.04050.x. PMid:15230837.
Plessas, I. N., & Volk, H. A. (2014). Signalment, clinical signs and treatment of atlantoaxial subluxation in dogs: A systematic review of 336 published cases from 1967 to 2013. Journal of Veterinary Internal Medicine, 28(3), 948. https://doi.org/10.1111/jvim.12323.
Ros, C., José-López, R., Suñol, A., Montoliu, P., Aige Dvm, V., de Carellán Mateo, A. G., & Font, C. (2022). Central cord syndrome: Clinical features, etiological diagnosis, and outcome in 74 dogs. Journal of the American Veterinary Medical Association, 260(7), 747-751. https://doi.org/10.2460/javma.21.08.0389. PMid:35201998.
Sanders, S. G., Bagley, R. S., Silver, G. M., Moore, M., & Tucker, R. L. (2004). Outcomes and complications associated with ventral screws, pins, and polymethyl methacrylate for atlantoaxial instability in 12 dogs. Journal of the American Animal Hospital Association, 40(3), 204-210. https://doi.org/10.5326/0400204. PMid:15131100.
Sharp, N. J., & Wheeler, S. J. (2005). Atlantoaxial subluxation. In N. J. Sharp & S. J. Wheeler (Eds), Small Animal Spinal Disorders: Diagnosis and Surgery (2nd ed., pp. 161-180). Elsevier Mosby. https://doi.org/10.1016/ B978-0-7234-3209-8.50013-3.
Shores, A., & Tepper, L. C. (2007). A modified ventral approach to the atlantoaxial junction in the dog. Veterinary Surgery, 36(8), 765-770. https://doi.org/10.1111/j.1532-950X.2007.00334.x. PMid:18067617.
Slanina, M. C. (2016). Atlantoaxial instability. The Veterinary Clinics of North America. Small Animal Practice, 46(2), 265-275. https://doi.org/10.1016/j.cvsm.2015.10.005. PMid:26631590.
Stout Steele, M. W., Hodshon, A. W., Hopkins, A. L., Tracy, G. M., Cohen, N. D., Kerwin, S. C., Boudreau, C. E., Thomas, W. B., Mankin, J. M., & Levine, J. M. (2016). Multi-center retrospective evaluation of screw and polymethylmethacrylate constructs for atlantoaxial fixation in dogs. Veterinary Surgery, 45(7), 909-915. https://doi.org/10.1111/vsu.12533. PMid:27580972.
Takahashi, F., Hakozaki, T., Kanno, N., Harada, Y., Yamaguchi, S., & Hara, Y. (2017). Biomechanical evaluation of three ventral fixation methods for canine atlantoaxial instability: A cadaveric study. The Journal of Veterinary Medical Science, 78(12), 1897-1902. https://doi.org/10.1292/jvms.16-0160. PMid:27593982.
Trębacz, P., Pawlik, M., Barteczko, A., Kurkowska, A., Piątek, A., Bonecka, J., Frymus, J., & Czopowicz, M. (2026). A comparison of two surgical treatment methods for atlantoaxial instability in dogs: Finite element analysis and a canine cadaver study. Materials (Basel), 19(2), 316. https://doi.org/10.3390/ma19020316. PMid:41598025.
Zani, C. C., Marinho, P. V. T., Minto, B. W., Lima, T. B., Moraes, P. C., & Laus, J. L. (2015). Atlantoaxial instability in dogs: Pathophysiology, clinical-surgical approaches and prognosis. Veterinária e Zootecnia, 22(2), 163-182.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Yuan Góes Ribeiro Campos, Murilo Henrique Dias da Silva, Isadora Villas Bôas Souza, Rafaela de Oliveira Cunha, Daniel de Pinho Alves, Carolina Camargo Zani Marinho, Adriano de Abreu Corteze, Paulo Vinícius Tertuliano Marinho

