ABSTRACT
STUDY DESIGN: Retrospective study. PURPOSE: To study the outcomes of two-level anterior cervical discectomy and fusion (2L-ACDF) versus hybrid total disc replacement (H-TDR) for cervical myeloradiculopathy. OVERVIEW OF LITERATURE: For bilevel disc issues of the cervical spine, 2L-ACDF has been a historical tool with numerous implants used at different time frames. Recent developments in total disc replacement at mobile level with fusion at a spondylotic level known as hybrid fixation have added a new armamentarium for such disorders. METHODS: An analysis of 49 consecutive patients who underwent 2L-ACDF (n=22) and H-TDR (n=27) from January 1, 2014 to December 31, 2017 was performed. Data were studied as retrieved from InstaPACS ver. 4.0 (Mediff Technologies Pvt. Ltd., Bengaluru, India) and medical records. RESULTS: Twenty-two patients with 2L-ACDF and 27 patients with H-TDR were included. The mean±standard deviation (SD) follow-up duration was 4.0±1.5 years in H-TDR and 3.1±1.1 years in 2L-ACDF. The mean±SD Neck Disability Index (NDI) decreased from 26.1±7.6 to 6.5±3.9 in the H-TDR group and from 27.6±7.2 to 6.4±4.8 in the 2L-ACDF group at final follow-up. Disc height at suprajacent level in the 2L-ACDF group was 4.12±0.48 mm, 4.10±0.45 mm, and 4.05±0.48 mm preoperatively, at 1-year, and final follow-up, respectively. Disc height at supradjacent level in the H-TDR group was 4.28±0.36 mm, 4.20±0.32 mm, and 4.19±0.34 mm preoperatively, at 1-year, and final follow-up, respectively. CONCLUSIONS: There was significantly improved NDI in both groups. Adjacent segment disc height loss was greater in the 2L-ACDF group than in H-TDR but not statistically significant (p =0.304). Supradjacent segment range of motion was greater in the 2L-ACDF group than in the H-TDR group (p =0.003). Both findings supported radiographic adjacent segment degeneration (ASD), but symptomatic ASD was absent in both groups.
ABSTRACT
ABSTRACT: Quadriparesis after intramuscular trigger point injections for myofascial pain syndrome has been rarely reported in the literature. A 37-year-old male patient presented with myofascial pain syndrome and was given trigger point injections in trapezius muscles under ultrasound guidance. The patient noticed weakness in all the 4 limbs at approximately 12 hours after the procedure, which gradually progressed to functional quadriplegia at the time of presentation to the emergency department. On examination, he had quadriparesis with no sensory involvement and superficial reflexes were normal. MRI screening of the whole spine was unremarkable, and MRI brain suggested an incidental granuloma, which could not explain his symptoms. Blood tests revealed severe hypokalemia (2.2 mEq/L) and deranged thyroid function tests. Immediate potassium correction with intravenous and oral potassium chloride was initiated, and the patient showed improvement within 6 hours of initiating correction. Stress of the procedure, use of steroids with mineralocorticoid effects such as methylprednisolone, or deranged thyroid function tests may have acted as triggers to precipitate hypokalemic paralysis in the patient. Knowledge of this complication is essential as prompt diagnosis and timely management of hypokalemia can result in complete resolution of the symptoms.
