CERVICAL MYELORADICULOPATHY WITH ENTRAPMENT NEUROPATHY - A STUDY BASED ON THE DOUBLE-CRUSH CONCEPT

In an attempt to formulate a standardised approach to the diagnosis an d management of patients with the double-crush syndrome, we reviewed 6 5 surgical cases (39 men and 26 women) with cervical myeloradiculopath y associated with entrapment neuropathy in the arm by examining the cl inical features, results of nerve conduction velocity studies and dist ribution of the vertebral levels of compression. Fifty-three patients (average age, 43 years) presented with a carpal tunnel syndrome at the wrist and cervical lesions (41 with spondylosis and 12 with ossified posterior longitudinal ligament), while 12 had a cubital tunnel syndro me at the elbow with cervical lesions (eight with spondylosis and four with ossification of the posterior longitudinal ligament). In the for mer group, the lesions were found mostly at C5-6 and C6-7 levels, whil e in the latter group involvement of C6-7 was frequently observed. Two patients in each group required additional cervical decompression aft er carpal or cubital tunnel release. A retrospective review of our pat ients suggested that it is reasonable to pursue an accurate diagnosis followed by treatment based on individual neurological and electrophys iological findings, but taking into consideration the significant leve l of physical impairment associated with cord compromise, we believe t hat it may be reasonable to perform a cervical decompression rather th an peripheral nerve release in such cases. Our findings suggest that o ne should be aware of a double-crush during examination of patients co mplaining of neck and hand problems.