Conclusion
Severe hemorrhage from the vertebral venous plexus occurs infrequently during intraoperative repair of cervical fractures and luxations. However, if present it can prohibit the standard surgical approach of fracture reduction from axial traction followed by stabilization using internal implants. Preplacement of pins into the vertebrae followed by enshrouding of PMMA cement and application of axial traction while the cement is still in the liquid phase facilitated fracture alignment and fixation with limited hemorrhage. The clinical outcomes of two dogs that underwent this technique were excellent and could return to unrestricted, pain-free activities.
Summary
Surgical repair of fractures and luxations of the cranial cervical vertebrae can be complicated by vertebral venous plexus hemorrhage following fracture fragment manipulation and realignment. Severe hemorrhage is potentially life threatening and may preclude definitive surgical fixation if it cannot be acceptably controlled and interferes with fixation technique. This report describes this scenario and a surgical strategy in two dogs with fractures of the second cervical vertebra. The surgical technique to limit hemorrhage included the insertion of the pins into the vertebrae, placement of collagen fleece, and autogenous cancellous bone graft over the fracture site, and while the polymethylmethacrylate cement was still within the liquid phase, axial traction was employed. The long-term outcome was considered excellent with both dogs able to ambulate unassisted and free from signs of pain. Although it is uncommon, severe vertebral venous plexus hemorrhage can occur during cervical vertebrae fracture repair. This technique provides a means to achieve internal fixation while concurrently limiting hemorrhage.
