The story of Tommy

At Veterinarium, an 11-month-old Yorkshire Terrier, Tommy, was diagnosed with atlanto-axial subluxation, a condition characterized by instability between the first and second cervical vertebrae (C1-C2), which can result in spinal cord compression and neurological dysfunction.

At Veterinarium, great importance is placed on pre-anesthetic evaluation. Accordingly, prior to surgery the patient underwent:

• Laboratory testing - complete blood count, blood biochemistry profile, and electrolyte analysis
• Cardiac ultrasonography
• Thoracic radiography

The laboratory results were within normal limits. However, cardiac ultrasonography revealed certain changes, which were considered in developing an individualized anesthetic protocol for the patient.

Given the severity of the instability, surgical stabilization was undertaken. Fixation of the atlanto-axial joint was achieved using two transarticular threaded pins placed across the C1-C2 articulation, supplemented with an additional threaded pin inserted into the caudal aspect of the axis (C2) body. Bone cement was applied over the pins to reinforce fixation.

The procedure was particularly challenging due to the patient’s extremely small size (1.5 kg) and the dimensions of the vertebral body, which measured only 1.8 mm at its narrowest point and 4 mm at its widest. This required meticulous preoperative planning, microsurgical technique, and precise intraoperative execution.

Despite these challenges, the surgery was successfully performed by Dr. Lasha-Giorgi Japaridze, assisted by Mari Kapanadze and Luka Ghlonti. Intraoperative anesthetic complications were effectively managed by the attending anesthesiologist, Natia Robakidze.

Because of the surgery’s complexity and prolonged duration, recovery from anesthesia was slow, necessitating extended postoperative monitoring. The surgeon and anesthesiologist, together with the clinic staff, remained with the patient until 6:00 a.m. to ensure a safe anesthetic recovery, despite the absence of an overnight ward at Veterinarium.

Tommy’s postoperative rehabilitation is progressing well, and he is currently bright, alert, and stable. Due to the cardiac changes identified, the patient’s condition requires monitoring, and a follow-up echocardiographic examination is scheduled a few months after surgery.