Cubital tunnel surgery in patients with cervical radiculopathy: double crush syndrome?
To determine differences in clinical outcomes in patients harboring both cubital tunnel syndrome (CuTS) and cervical radiculopathy and the influence of the so-called double crush syndrome. Both procedures were performed in 24 patients, mean age 55 years; first group of 14 patients underwent CuTS surgery as a first procedure. Second group of 10 patients underwent anterior cervical discectomy and fusion (ACDF) then ulnar nerve release (UNR). Two patients underwent bilateral nerve surgery and six multiple cervical discectomies. Surgeries consisted in 26 nerve releases with associated external neurolysis in five, and 34 ACDF procedures, with plating in six. Clinical complaints (mean time 12 months) were sensory in 20 arms, with associated motor weakness and hypothenar atrophy involvement in another six. Electromyography changes were mild (two arms), moderate (16 arms), and severe (eight arms). Mean time of follow-up was 3 years (range 18 months-14 years). Clinical improvement was evidenced in 14 patients. Sensory nerve symptoms improved in 13 limbs in both groups and motor improvement was evident in three patients with UNR as first surgery. A comparative cohort of 20 patients with UNR but without cervical radiculopathy was studied to disclose outcome differences. Of these, 13 patients had clinical improvement. No differences were found among groups. In patients with double crush syndrome, factors that seemed to influence a poor CuTS outcome were evolution of symptoms longer than a year, history of multiple neuropathies or radiculopathies, and ACDF performed before UNR.
Galarza
Marcelo
M
Department of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. galarza.marcelo@gmail.com
Gazzeri
Roberto
R
Gazzeri
Giovanni
G
Zuccarello
Mario
M
Taha
Jamal
J
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003444:Crush Syndrome / Q000473:pathology / Q000601:surgery*; D020430:Cubital Tunnel Syndrome / Q000150:complications* / Q000601:surgery*; D019299:Decompression, Surgical; D017586:Diskectomy; D004568:Electrodiagnosis; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011843:Radiculopathy / Q000150:complications* / Q000601:surgery*; D013123:Spinal Fusion; D016896:Treatment Outcome; D017769:Ulnar Nerve Compression Syndromes / Q000601:surgery
J Hand Surg Am. 1984 Jan;9A(1):90-5
6693750
No To Shinkei. 2005 Oct;57(10):883-7
16277233
J Hand Surg Am. 1989 Nov;14(6):972-9
2531181
J Hand Surg Am. 2001 Nov;26(6):1077-81
11721254
Orthop Clin North Am. 1988 Jan;19(1):147-55
3275922
Spinal Cord. 1998 Jun;36(6):399-404
9648195
Acta Neurochir (Wien). 1996;138(3):308-13
8861700
Arch Phys Med Rehabil. 2004 Jun;85(6):1000-5
15179657
Electromyogr Clin Neurophysiol. 1994 Jun;34(4):195-6
8082604
J Hand Surg Am. 2000 May;25(3):544-51
10811760
Neurosurgery. 2004 Apr;54(4):891-5; discussion 895-6
15046655
J Hand Surg Am. 1989 Jul;14(4):688-700
2666496
Neurosurg Clin N Am. 2001 Apr;12(2):267-84
11525206
J Bone Joint Surg Am. 1990 Feb;72(2):213-9
2303507
Hand Clin. 1996 May;12(2):205-21
8724574
Spine (Phila Pa 1976). 1997 Mar 15;22(6):636-40
9089936
Neurophysiol Clin. 2003 Nov;33(5):219-22
14672822
J Hand Surg Am. 1999 Sep;24(5):898-905
10509266
J Hand Surg Br. 1993 Feb;18(1):106-10
7679703
J Hand Surg Am. 2004 May;29(3):373-8
15140474
Ann Chir Main Memb Super. 1990;9(5):331-40
1705129
J Hand Surg Br. 2000 Oct;25(5):453-6
10991811
Neurology. 1998 Jan;50(1):78-83
9443461
Clin Orthop Relat Res. 1991 Aug;(269):193-200
1864038
J Bone Joint Surg Br. 1950 Aug;32-B(3):293-301
14778847
Lancet. 1973 Aug 18;2(7825):359-62
4124532
J Hand Surg Br. 1992 Jun;17(3):248-50
1624852
Plast Reconstr Surg. 2000 Aug;106(2):327-34
10946931
J Hand Surg Am. 1981 Mar;6(2):181-92
7229295
J Neurol. 1999 Jul;246(7):544-51
10463354
Clin Orthop Relat Res. 1992 Jan;(274):231-7
1309492
J Hand Surg Br. 1985 Jun;10(2):202-4
4031604
Surg Neurol. 2000 Jun;53(6):524-9
10940418
Arch Phys Med Rehabil. 1986 May;67(5):290-2
3707312
Neurosurgery. 1996 Mar;38(3):458-65; discussion 465
8837796