Case report --surgical stabilization of a craniocervical junction abnormality with atlanto-occipital overlapping in a...

A 3-year-old male neutered Pomeranian presented with severe, poorly localizable pain that was unresponsive to a combination of oral medications (gabapentin, tramadol, prednisone, and methocarbamol) and a fentanyl patch. A Chiari-like malformation with associated syringomyelia was evident on magnetic resonance imaging (MRI). In addition, overlapping of the dorsal arch of C1 and the dorsal aspect of the foramen magnum was suspected from the MRI scans and verified via computed tomography, suggesting a condition similar to basilar invagination/impression in people. At surgery, a combination of foramen magnum decompression with cranioplasty and stabilization of the atlanto-occipital junction was performed. The atlanto-occipital junction was stabilized using an adaptation of a procedure used in people for basilar invagination/impression. Over the next several months, the dog's clinical signs improved dramatically, allowing substantial reduction of oral pain medications. This is the first report of surgical stabilization for atlanto-occipital overlapping in a dog.