# Salvage Stabilization via Transthoracic Approach for Congenital Vertebral Malformations in a Toy Breed Dog: A Case Report

## TL;DR

A Pomeranian with a spinal deformity regained full mobility after a third surgery using a chest approach when standard back surgeries failed.

## Contribution

First successful use of a transthoracic approach for spinal stabilization in a toy breed dog with congenital vertebral malformations.

## Key findings

- The transthoracic approach enabled successful stabilization using titanium screws and PMMA in a Pomeranian with failed dorsal surgeries.
- The dog regained full ambulatory function within four weeks and maintained it for 19 months post-surgery.
- This approach is effective when conventional methods fail due to the fragile vertebrae in toy breeds.

## Abstract

Congenital vertebral malformations are spinal deformities that can cause paralysis in dogs. While surgery is often needed, it can be very difficult in tiny “toy” breeds like Pomeranians because their vertebrae are diminutive and fragile. This report describes a case of a 7-month-old Pomeranian that underwent two standard surgeries through the back (dorsal approach) to fix a spinal deformity, but both failed. We then performed a third “salvage” surgery, approaching through the chest (transthoracic approach) to stabilize the spine from the side. This method allowed us to use stronger bone for screw fixation. The dog recovered its walking ability completely. This case shows that the chest approach can be a successful alternative for saving toy breed dogs when standard back surgeries fail.

This case report describes the successful management of a 7-month-old Pomeranian with congenital vertebral malformation (CVM) causing kyphosis and progressive myelopathy, characterized by non-ambulatory paraparesis, decreased postural reactions, and increased spinal reflexes in the hind limbs. Initial management involved a dorsal approach for decompression and stabilization; however, the patient failed to regain hindlimb function. Following two failed surgical attempts due to implant failure and progressive instability, a salvage stabilization was performed using a transthoracic approach. Stabilization was achieved using titanium screws and polymethyl methacrylate (PMMA) applied to the vertebral bodies. The patient exhibited marked postoperative improvement, regaining weight-bearing ability within one week and achieving a normal gait by four weeks. At the 19-month follow-up, the dog maintained normal ambulatory function with no recurrence of neurological deficits. While the transthoracic approach is well-documented in brachycephalic breeds, this is the first report describing its successful application in a toy breed. This case highlights the transthoracic approach as a highly effective salvage technique, offering a novel solution when conventional dorsal elements are irreversibly compromised due to the extremely diminutive and fragile nature of toy breed vertebrae.