Postoperative Functional Analysis of Double Crush Versus Single Peripheral Nerve Decompression: A Retrospective Study

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Rehabilitation Medicine

Background:

• Double crush (DC) syndrome involves concurrent cervical radiculopathy and peripheral nerve compression.
• Patients with DC syndrome may experience increased nerve irritability and weakness postoperatively.
• Surgical decompression at both cervical spine and wrist may lead to inferior patient-reported outcomes compared to single-site decompression.

Purpose of the Study:

• To compare patient-reported outcomes following combined cervical and wrist decompression versus single-site decompression.
• To evaluate the impact of double crush syndrome on postoperative functional disability and pain.

Main Methods:

• Retrospective analysis of 477 patients undergoing anterior cervical decompression and fusion (ACDF), carpal tunnel release (CTR), or both (DC) within 5 years.
• Postoperative outcomes assessed using Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Neck Disability Index, and visual analog scale (VAS) scores.
• Outcomes collected at an average of 2 years postoperatively.

Main Results:

• Higher QuickDASH scores in the DC group compared to the CTR group (36 vs 22, P < .0002).
• ACDF group showed significantly higher postoperative disability than the DC group (50 vs 36, P < .017).
• CTR group reported greater arm pain intensity than the DC group (5.7 vs 3.6, P < .01).

Conclusions:

• Combined ACDF and CTR result in greater postoperative disability than CTR alone.
• Cervical radiculopathy appears to contribute significantly to long-term postoperative disability.
• Higher postoperative arm pain in the CTR-alone group suggests potential undiagnosed cervical radiculopathy.