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Atlantoaxial instability (aai) – an update regarding therapy and prognosis
Forterre F.
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The atlantoaxial instability/subluxation is a congenital – in some cases also acquired – disease, which leads to the impairment of the spinal cord between the first two cervical vertebrae.
Anatomically there is no intervertebral disc located in between those two adjacent vertebrae. The Dens axis is connected to the Atlas through the transverse ligament, the apical ligament, and the paired alar ligaments. As the name already suggests, the dorsal atlantoaxial ligament runs dorsally in between the spinous process of the axis and the dorsal arch of the atlas. A new biomechanical study in dogs has shown that the alar ligaments are the most important ligaments for stabilization of the atlantoaxial joint whilst under the impact of shear force.
The congenital form of instability is observed most frequently, while trauma is a less common source resulting in failure of the normal anatomical structures. Miniature breeds such as Yorkshire Terrier, Chihuahua, Pomeranian, Prager Rattler and various others are predominantly affected. Large breed dogs as well as cats are far less affected. In most cases, absence or hypoplasia of the dens axis (46%), malformation of the dens (30%) or a normal dens axis (24%) with agenesia or dysgenesia of the ligamentous structures is present (4). Clinical signs of congenital instability mostly occur within the first year of life. In subclinical cases, trauma may often lead to deterioration of the clinical status and manifestation of the problem. [...]
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