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 (<i>p</i> =0.304). Supradjacent segment range of motion was greater in the 2L-ACDF group than in the H-TDR group (<i>p</i> =0.003). Both findings supported radiographic adjacent segment degeneration (ASD), but symptomatic ASD was absent in both groups.

Introduction We report a case of pneumocephalus and pneumorachis i.e., air in the cranial cavity and the spinal canal, which are rarely associated with a primary spinal cause. Their concomitant occurrence and association with a late presenting dural leak are also uncommon. Case presentation A 70-year-old man presented 1 month after decompressive surgery for lumbar canal stenosis with leakage of cerebrospinal fluid (CSF) from the wound site and severe headache. There were no signs of surgical site infection or meningitis. There was no intraoperative or immediate postoperative evidence of dural tear. He was neurologically intact. On detailed work-up, he was found to have air collections in the subarachnoid and intraventricular spaces in the brain and intraspinal air in both the cervical and the lumbar regions. He showed gradual resolution of these findings radiologically and symptomatic improvement through conservative management with analgesics, empirical antibiotics, high flow oxygen, and maintenance of hydration within 1 month. Discussion Pneumocephalus and pneumorachis are commonly seen after trauma. Spine surgery is a rare cause. They may present with symptoms similar to meningitis and may be erroneously diagnosed and treated. No standard treatment guidelines exist in the literature. Most cases have been managed conservatively. Early detection may allow noninvasive management leading to complete resolution.

Study design: Single-arm prospective phase I/II clinical trial Objective: Standing and walking are highly desirable goals forpersons with spinal cord injury (SCI). Spinal epidural electrical stimulation (sEES) has been utilized to produce rhythmic activity in animals and more recently, in a few human case reports. Our objective was to assess the safety and efficacy of sEES in the recovery of motor function after severe SCI. Setting: Indian Spinal Injuries Center, New Delhi Methods: Fiveparticipantssatisfying the eligibility criteria includingsevere and chronic SCIand an absence of useful power in the lower limbswere included in the study. The Institute Ethics Committee and the Research Review Committee approved the study and it was registered with Clinical Trials Registry of India. Results: No intraoperative or early postoperative complications were noted in any of the participants. Two participants had wound complicationsat 1 and 3 months respectively and were managed successfully.Improvement in the voluntary power of lower limbs, motor abilities, and functional recoverywas noted in the majority of the participants when the sEESwas turned on. Even with sEES turned off; there was improvement in motor abilities of a participant though there was no demonstrable neurological recovery. Conclusions: sEES is a safe intervention and improves the motor and functional abilities of persons with severe and chronic SCI. Neurological recovery could not be demonstrated. However, a larger,prospective,matched controlledstudy with more participants needs to be done to draw a definite conclusion.