Double Crush Syndrome in Surgically-Treated Lumbosacral Radiculopathy: Prevalence, Risk Factors, and Clinical...

Double crush syndrome (DCS) refers to compressive neuropathy at multiple sites along a peripheral nerve (PN), yet its relevance in the lower extremity remains poorly defined. This study aimed to (1) determine the prevalence of PN lesions in patients undergoing surgery for lumbosacral radiculopathy (LR), (2) identify commonly affected nerves, (3) assess associated risk factors, and (4) evaluate the DCS hypothesis by comparing the incidence of PN lesions in patients undergoing surgery for LR versus matched controls.

A retrospective cohort study was conducted using the PearlDiver database (2010-2022) to identify adult patients who underwent lumbar decompression and/or fusion for LR. PN lesions diagnosed within two years before or after surgery were categorized by nerve. Univariate logistic regression was used to identify risk factors. A matched control cohort without LR was created using propensity score matching to evaluate the DCS hypothesis.

Of 650,562 patients undergoing surgery for LR, 32,909 (5.1%) were diagnosed with a PN lesion, with 60.6% occurring before and 38.4% after surgery. The most commonly affected nerves were the sciatic (31.7%), plantar (16.1%), and peroneal (11.2%). Risk factors for PN lesions included female gender (odds ratio [OR]: 1.22), age 50-59 years (OR: 1.23) and 60-69 years (OR: 1.17), and higher comorbidity burden with Elixhauser Comorbidity Index ≥5 (OR: 1.50). Comorbid conditions associated with increased risk included complex regional pain syndrome (OR: 3.33), fibromyalgia (OR: 1.73), and osteoarthritis (OR: 1.61). Compared to matched controls, patients with LR were significantly more likely to develop a PN lesion (OR: 3.10).

PN lesions affect over 5% of patients undergoing surgery for LR and are significantly more common than in controls, supporting the DCS hypothesis in the lower extremity. Clinicians should maintain a broad differential diagnosis when evaluating radicular symptoms, especially in patients with high comorbidity burden or recurrent postoperative pain.