Plus-Hex CLINICAL
Introduction
A spinal subarachnoid diverticulum( SAD) is a fluid-filled dilation within the subarachnoid space that can compress the spinal cord [ 1 ]. The aetiopathogenesis is undetermined, although it has been suggested that there are congenital or acquired factors, as SADs are commonly seen in pugs, French bulldogs and rottweilers [ 2 ]. In veterinary patients, SADs are diagnosed by magnetic resonance imaging( MRI) and can be treated with medical management or surgical intervention. Medical management treats the clinical signs, which are secondary to the compression of the spine, and outcomes are often improved by surgical intervention [ 2 ]. Surgical treatment involves a dorsal laminectomy, which exposes the spinal cord by removing a small window of bone over the top of the spinal column [ 3 ]. Durotomy closure is used, as this can aid in reducing the risk of a cerebrospinal fluid( CSF) leak [ 4 ].
There are limited data regarding the outcome of this procedure in association with an SAD; however, a study of eight dogs by Spinillo et al. [ 5 ] identified a satisfactory outcome 7 – 36 months postoperatively, although they observed mild deterioration on recovery in all dogs. Similarly, the study of Alisauskaite et al. [ 6 ] had a successful outcome in 82 % of cases, but they also identified a late onset of clinical signs after the initial postsurgical improvement in 85 % of the cases. These data confirm that nursing a patient following a dorsal laminectomy can be challenging and appropriate care is essential for optimal recovery.
This nursing care analysis explores the complexities of the postoperative management of a dog after a dorsal laminectomy, with particular emphasis on pain assessment, optimisation of analgesic protocols, and the challenge of differentiating true pain from anxiety-related behavioural signs. Intensive nursing interventions included a continuous infusion of ketamine and administration of methadone guided by pain scores obtained using the Glasgow Composite Pain Scale. Regular repositioning, bladder care and structured physiotherapy were provided to support neurological recovery and reduce the risk of secondary complications. As the patient became increasingly recumbent and displayed anticipatory distress on handling, pain scoring grew more challenging and prompted concern that anxiety might be mimicking or amplifying observed pain behaviours.
Patient signalment
Name Species Breed Age
Nala Dog Rottweiler 1 year Sex Female( entire) Weight
36 kg
Admission
Nala( not pictured) was originally admitted to the hospital due to a 3-month history of lethargy and ataxia. MRI was conducted, revealing a subarachnoid diverticulum at C5 – C6. Forty-eight hours following general anaesthesia for the MRI, the patient was readmitted exhibiting tetraplegia and exacerbation of pain. The findings were consistent with the potential necessity for surgical intervention.
Assessment
On presentation, Nala was non-ambulatory and seemed to be in pain when moving freely. She had previously presented with pyrexia; therefore, her temperature was rechecked, and her heart and respiration rate were auscultated and monitored; all values were within their normal ranges. Abdominal palpation was normal and there was no vulval discharge present. There was no evidence of thoracolumbar or joint pain, although when Nala voluntarily moved her neck, she yelped. The neurological examination revealed ambulatory tetraparesis. Her paw placement and hopping on all four limbs were delayed, with the hindlimbs being worse affected. It was also found that she had reduced withdrawal reflexes in her forelimbs.
Investigations
Nala was admitted and routine preoperative blood tests were conducted( haematology, biochemistry and electrolytes); these revealed raised neutrophil and white blood cell counts( Table 1), indicating the possibility of infection or inflammation [ 7 ]. Abdominal ultrasonography was conducted to rule out the possibility of pyometra due to the clinical signs of weakness and lethargy, but nothing abnormal was detected [ 8 ].
Table 1. The patient ' s haematology results.
Parameter( unit) Result
Reference range
White blood cells(× 10 9 / l) 21.99 5.8 – 16.2 Neutrophils(%) 85.3 Lymphocytes(%) 9.9 Monocytes(%) 4.5 Eosinophils(%) 0.1 Basophils(%) 0.2 Neutrophils(× 10 9 / l) 18.75 2.94 – 12.67 Platelets(× 10 9 / l) 541.0 148.0 – 484.0 Plateletcrit( PCT)(%) 0.59 0.14 – 0.46
Volume 41( 3) • June 2026
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