Dancing Dorsal Quadrilaterals: Case Report

Peripheral injury-induced movement disorders encompass a broad spectrum of conditions characterized by involuntary movements resulting from injuries to the peripheral nervous system. While most reported cases are associated with traumatic events-such as nerve lacerations-surgical interventions are also recognized as potential triggers of such disorders. This article aims to report a rare presentation of dancing dorsal quadrilateral syndrome (DDQS) following spinal surgery with instrumentation. A 63-year-old man presented with back pain and neck pain and was diagnosed with Scheuermann's disease. He underwent thoracic spinal fusion with pedicle screw instrumentation to correct hyperkyphosis. Six months after surgery, he began to experience a burning pain in the bilateral subscapular region along with abnormal and involuntary movements in the dorsal musculature. The motor unit potential followed an ascending-descending pattern, and these findings were compatible with dyskinesia, specifically DDQS. A joint management approach with a clinical neurologist was indicated, including the prescription of muscle relaxants and the administration of botulinum toxin in the dorsal quadrilaterals, resulting in partial improvement of the condition. Treatment options range from addressing afferent nerve injury, which can sometimes be curative in some focal dyskinesias, to the use of botulinum toxin for symptomatic relief, as presented in the above case. Additional research is warranted to better understand the pathophysiology of DDQS and to optimize treatment strategies for this uncommon but clinically significant condition.