Internal fixation of a complete ventral luxation of the dens axis in an American quarter horse yearling.
Authors: Schulze Nicole, Ehrle Anna, Noguera Cender Andrea C, Lischer Christoph
Journal: Veterinary surgery : VS
Summary
Complete atlantoaxial luxation—where the first and second cervical vertebrae completely dislocate—carries a grave prognosis in horses, typically resulting in euthanasia due to the severity of neurological compromise. This case report documents the surgical management of a one-year-old American Quarter Horse filly using a 4.5-mm T-locking compression plate combined with four 5.5-mm lag screws placed across the atlantoaxial joint after closed and open reduction attempts proved unsuccessful; the dens axis was excised to facilitate stabilisation. Nine months post-operatively, the filly recovered without complication, demonstrated normal development, and showed no signs of ataxia or restricted neck mobility—outcomes that represent a departure from the uniformly poor prognosis typically associated with this injury. For equine veterinary surgeons, this case establishes that surgical fixation of complete atlantoaxial luxation, when manual reduction fails, offers a realistic alternative to euthanasia and may preserve valuable young horses. Whilst this remains a rare and technically demanding procedure requiring specialist facilities and expertise, the successful outcome challenges practitioners to consider aggressive surgical intervention in select cases rather than accepting the traditionally fatal consequences of this injury.
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Practical Takeaways
- •Complete atlantoaxial luxation is a treatable surgical emergency in young horses; internal fixation should be considered before accepting poor prognosis
- •T-locking compression plate stabilization combined with lag screw fixation provides adequate biomechanical stability for atlantoaxial fusion in equine patients
- •Young horses can achieve full functional recovery and normal growth following atlantoaxial surgical stabilization if managed appropriately post-operatively
Key Findings
- •Surgical stabilization of complete atlantoaxial luxation using 4.5-mm T-locking compression plate with lag screws resulted in successful outcome
- •Horse recovered uneventfully and showed normal development 9 months post-surgery with no ataxia or reduced neck mobility
- •Internal fixation approach represents first reported favorable outcome for this condition in equine medicine, contrasting with historically poor prognosis