A. Turkmani1, M. Munim1, A. Butler1, V. Federico1, H. Pawlowska1, X. Simcock1, M. W. Colman1 1Rush University Medical Center, Department Of Orthopedic Surgery, Chicago, IL, USA
Introduction:
Double crush syndrome involves two distinct compressive lesions along the course of a single peripheral nerve. Frequently, patients with compressive neuropathies at the wrist and elbow may experience exacerbated pain, numbness, and weakness from concomitant cervical radiculopathy. Surgical management aims to provide decompression at either or both proximal and distal sites. The purpose of this study was to compare postoperative outcomes of anterior cervical discectomy and fusion (ACDF) with and without subsequent peripheral nerve decompression in patients with double crush syndrome.
Methods:
This study retrospectively evaluated patients with double crush lesions of the cervical spine and upper extremity, presenting with concomitant diagnoses of cervical radiculopathy and either carpal or cubital tunnel syndrome. Two cohorts were identified and matched by age and gender: patients treated with ACDF alone versus patients treated with both ACDF and a subsequent peripheral nerve decompression via either a carpal or cubital tunnel release. All procedures were performed at a single institution between 2004 and 2020, with minimum 1-year follow-up. Postoperative symptom severity, examination findings, patient-reported outcomes, and subsequent reoperations were compared between cohorts.
Results:
A total of 130 patients were included for analysis (N = 66 receiving ACDF alone, N = 64 receiving ACDF with subsequent peripheral nerve decompression). No significant differences were observed between groups in baseline clinical charecteristics. Patients receiving ACDF with subsequent peripheral nerve decompression experienced a significantly longer duration of pre-operative radicular/peripheral symptoms (29.2 months vs. 18.3 months, P < 0.001). At latest follow-up, patients receiving ACDF alone exhibited significantly greater frequencies of persistent numbness, signs of nerve irritability via positive provocative Phalen’s/Tinel tests, and reduced 2-point discrimination, compared to patients receiving both procedures (Table 1). No significant differences in muscle weakness or pathologic reflexes were observed. Patients receiving ACDF with subsequent peripheral nerve decompression reported substantially greater improvements in VAS Neck Pain, VAS Arm Pain, and NDI scores compared to patients receiving ACDF alone, despite comparable baseline scores. Subsequent cervical or upper extremity reoperation rates were similar between cohorts (17.2% vs. 27.3%, P = 0.167).
Conclusion:
In patients with double crush neuropathies, isolated decompression at the cervical spine may be insufficient. Comprehensive treatment of both proximal and distal lesions provided superior resolution of pain, disability, and persistent sensory deficits.
