Clinical features, diagnostic imaging findings, treatment, and outcome of a cat with C4 vertebral fracture and concomitant tracheal rupture.

Background: Vertebral fractures are relatively common in cats, affecting the thoracic or lumbar spine more frequently than the cervical region. Patient history and clinical signs at presentation often guide the initial diagnostic suspicion; however, advanced imaging techniques are usually essential for establishing a definitive diagnosis. The management of these cases is often complex, and not all patients require surgical intervention. When surgery is indicated, the primary goal is to decompress the spinal cord and prevent further secondary injury. Case Description: A 3-year-old female domestic shorthair cat was referred for suspected bite trauma to the neck region. The cat presented with subcutaneous emphysema of the neck and cranial thorax, and pain on manipulation, associated with non-ambulatory tetraparesis, consistent with C1-C5 neurolocalization. Thoracic radiographs confirmed subcutaneous emphysema, pneumomediastinum, and mild pneumothorax, without signs of cervical injuries. Computed tomography (CT) confirmed a vertebral fracture, involving the dorsal lamina of C4, along with tracheal rupture. Surgical treatment via a dorsal approach was performed, and the fractured vertebral fragment was removed to decompress the spinal cord, while the tracheal rupture was managed conservatively. Postoperatively, the cat showed progressive clinical improvement, and 3 months after the trauma, normal ambulation was completely resumed. Conclusion: To the best of the author's knowledge, this is the first case report describing a C4 vertebral fracture associated with tracheal rupture in a cat, managed successfully through surgical decompression without the need for vertebral stabilization. Diagnosis can be challenging without advanced diagnostic imaging; thus, in this case, the radiographic study failed to detect the vertebral fracture, which was shown only on CT imaging. Establishing a prioritization protocol in patients with multiple concurrent injuries is both challenging and critical, and should be guided by clinical status and imaging findings. Surgical intervention should always be considered for unstable or compressive cervical fractures to avoid secondary neurological deterioration, potentially leading to a rapid and favorable outcome.