Artikel
How does double crush syndrome affect the outcome in patients with cubital tunnel syndrome and ulnar nerve decompression? A retrospective analysis
Wie beeinflusst das Double-crush Syndrome das Outcome von Patienten mit Dekompression des N. ulnaris bei Kubitaltunnelsyndrom? Eine retrospektive Analyse
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Autoren
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Dörthe Keiner
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Saarbrücken, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Saarbrücken, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Double crush syndrome is a multifactorial syndrome defined by mechanical compression of a peripheral nerve and additional lesion of the compromised nerve by further mechanical, systemic, or pharmacological pathologies. It has been associated with an inferior outcome regarding improvement of symptoms and patient satisfaction after surgical treatment.
Methods: Between January 2011 and October 2020, 273 ulnar nerve decompression procedures for cubital tunnel syndrome (CuTS) have been performed in the authors' department. Retrospective analysis of patients with double crush syndrome with emphasis on the clinical outcome was performed. The diagnosis was based on simultaneous clinical and electrophysiological signs of CuTS and cervical nerve root compression, and MR-imaging of the cervical spine showing mechanical compression at level C6/7 and/or C7/Th1.
Results: Simultaneous CuTS and cervical degeneration was found in 76/273 cases (27.8%). Twenty-three cases (8.4%) were classified as double crush syndrome; all patients underwent previous spine surgery. After ulnar nerve decompression, 65.2% of patients had regular sensibility or residual sensory deficit. Preoperative regular motor function was observed in 34.8% of patients. Postoperatively, regular motor function or marked improvement was observed in 82.6% of patients. Preoperative pain was reported in 69.6% of patients, persisting postoperative pain was reported in 38.8% of patients. Analysis of the entire CuTS cohort revealed that at last postoperative follow-up, 68.5% of patients had regular sensibility or residual sensory deficit. Preoperative motor function was regular in 24.2% of patients. Postoperatively, motor function was regular or had markedly improved in 73.7% of patients. Preoperative pain was reported in 51.7% of patients; persisting postoperative pain was reported only in 13.4% of patients of the entire group.
Conclusion: While the outcome of sensory and motor symptom relief was similar in patients with double crush syndrome compared to the entire cohort, persisting pain was reported more commonly in patients with double crush syndrome. Patients with double crush syndrome should be counseled that despite successful decompression and improvement of sensory-motor deficits, pain relief might be not as good and satisfactory compared with patients who are treated for isolated entrapment neuropathies. Further, findings should be confirmed in a prospective study.
