Cervical myeloradiculopathy with entrapment neuropathy: a study based on the double-crush concept

Abstract

In an attempt to formulate a standardised approach to the diagnosis and management of patients with the double-crush syndrome, we reviewed 65 surgical cases (39 men and 26 women) with cervical myeloradiculopathy associated with entrapment neuropathy in the arm by examining the clinical features, results of nerve conduction velocity studies and distribution 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 ossi®ed posterior longitudinal ligament), while 12 had a cubital tunnel syndrome at the elbow with cervical lesions (eight with spondylosis and four with ossi®cation of the posterior longitudinal ligament). In the former group, the lesions were found mostly at C5 ± 6 and C6 ± 7 levels, while in the latter group involvement of C6 ± 7 was frequently observed. Two patients in each group required additional cervical decompression after carpal or cubital tunnel release. A retrospective review of our patients suggested that it is reasonable to pursue an accurate diagnosis followed by treatment based on individual neurological and electrophysiological ®ndings, but taking into consideration the signi®cant level of physical impairment associated with cord compromise, we believe that it may be reasonable to perform a cervical decompression rather than peripheral nerve release in such cases. Our ®ndings suggest that one should be aware of a double-crush during examination of patients complaining of neck and hand problems.

Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy

“…The male predominance of cervical radiculopathy in the previous report is diVerent from our present study, which shows similar percentages of sole cases of CR in both sexes, and even higher percentages of cervical radiculopathy in women when DCS was taken into account. The higher percentage of DCS in women in our present study was also contrasted with previous studies, which found higher incidence of DCS in men [3,14]. We postulated that the diVerence may be due to diVerent susceptibility to cervical radiculopathy in the Asian population, the impact of changing human lifestyle, and the working conditions of women in the last two decades.…”

“…In 1973, Upton and McComas postulated that nonsymptomatic impairment of axoplasmic Xow at more than one site along a nerve might summate to cause symptomatic neuropathy [1]. This concept is supported by later studies that found association between cervical myeloradiculopathy and carpal tunnel syndrome [2], which increase the incidence of bilateral carpal tunnel syndrome in patients with cervical arthritis [3]. Other studies that found the association between cervical radiculopathy and carpal tunnel syndrome failed to demonstrate the etiological relationship between these two conditions [4,5].…”

Cervical spondylotic amyotrophy

“…Cervical spondylosis often manifests with spastic tetraparesis with varying degrees of sensory dysfunction [6,10,11,14,26,45]. Crandall et al [10] indicated that somewhat less than 7% of patients with cervical spondylotic myelopathy present with minimal sensation loss, and classified this subtype of the disorder as cervical spondylotic amyotrophy.…”

The “Hierarchical” Scratch Collapse Test for Identifying Multilevel Ulnar Nerve Compression

“…The double crush hypothesis also suggests that serial constraints to axoplasmic flow, while individually are insufficient to result in clinically appreciable nerve dysfunction, can be an additive in causing ultimate nerve dysfunction. There exists both clinical and experimental evidence to support multiple compression sites in peripheral nerves [1,6,7,14,17,21,23,27,32]. Other potential etiologies include medical conditions which increase the susceptibility of compression (e.g., diabetic neuropathy), neurologic conditions (e.g., syringomyelia), and genetic Fig.…”