Surgical Management of Double Crush Syndrome: Outcomes of Cervical Decompression With and Without Peripheral Nerve Release

Abstract

Purpose

Double crush syndrome involves two distinct compressive lesions along a single peripheral nerve. Patients with compressive neuropathies at the wrist and elbow may experience exacerbated symptoms from cooccurring cervical radiculopathy. Surgical management aims to decompress at either or both proximal and distal sites. This study compares outcomes of anterior cervical discectomy and fusion (ACDF) alone versus ACDF with subsequent peripheral nerve decompression.

Methods

This retrospective study evaluated patients with double crush lesions, diagnosed with magnetic resonance imaging-confirmed cervical radiculopathy and carpal or cubital tunnel syndrome via electrodiagnostic confirmation. Two cohorts were matched and analyzed: (1) ACDF alone and (2) those with ACDF with subsequent peripheral nerve decompression. All procedures were performed at a single institution between 2004 and 2020, with a minimum 1-year follow-up. Postoperative symptoms, examination findings, patient-reported outcomes, and reoperations were compared.

Results

Among 130 patients (66 receiving ACDF alone, 64 with additional peripheral nerve decompression), those with both procedures had a significantly longer duration of preoperative radicular/peripheral symptoms (29.2 months vs 18.3 months). At the latest follow-up, patients receiving ACDF alone had significantly more persistent numbness (42.4% vs 17.2%), nerve irritability (21.2% vs 4.7%), and reduced 2-point discrimination (20.3% vs 12.1%) when compared with those who had bimodal decompression. Patients receiving both procedures reported significantly greater improvements in visual analog scale neck pain (−5.62 vs −3.63), visual analog scale arm pain (−4.73 vs −3.54), and neck disability index scores (−17.50 vs −6.80).

Conclusions

Isolated cervical decompression may be insufficient for double crush neuropathies. Treatment of both proximal and distal sites can provide superior pain and symptom relief. Management of compressive pathology at both sites should be strongly considered by treating surgeons.

Type of study/level of evidence

Therapeutic III.