A Comparison of Two Surgical Treatment Methods for Atlantoaxial Instability in Dogs: Finite Element Analysis and a Canine Cadaver Study

Atlantoaxial instability (AAI) in toy- and small-breed dogs remains a significant clinical challenge, as the restricted anatomical space and risk of complications complicate the selection of implants. This study aimed to compare three patient-specific Ti-6Al-4V stabilizers for the C1-C2 region: a clinically used ventral C1-C3 plate, a shortened ventral C1-C2 plate, and a dorsal C1-C2 implant. Computed tomography, segmentation, virtual reduction, CAD/CAM design, and finite element analysis were employed to evaluate the linear-static mechanical behavior of each construct under loading ranging from 5 to 25 N, with a focus on displacements, von Mises stresses, and peri-screw bone strains. Additionally, cadaver procedures were performed in nine small-breed dogs using custom drill guides and additively manufactured implants to evaluate procedural feasibility and implantation time. Finite element models demonstrated that all stabilizers operated within material and biological safety limits. The C1-C3 plate exhibited the highest implant stresses, while the C1-C2 plate demonstrated an intermediate response, and the dorsal implant minimized implant stresses, albeit by increasing bone stresses. Cadaver experiments revealed that dorsal fixation required less implantation time than ventral fixation. Collectively, the findings indicate that all evaluated constructs represent safe stabilization options, and the choice of implant should reflect the preferred load-transfer pathway as well as anatomical or surgical constraints that may limit ventral access.