Medical Student Department of Neurosurgery, Duke University School of Medicine, Durham, NC Durham, North Carolina, United States
Introduction: Double Crush Syndrome (DCS) involves nerve compression at both proximal and distal points along a nerve pathway, causing neurological symptoms. While DCS is well-researched in the upper extremities with incidence rates between 6.7% and 73%, its prevalence in the lower extremities remains unclear, with no standardized incidence rate. The lack of diagnostic criteria for lower extremity DCS can result in delayed care, misdiagnosis, and increased healthcare costs, which could negatively impact patients' mobility and quality of life. This study aims to determine the incidence of lower extremity DCS in patients undergoing surgery for concurrent lumbar radiculopathy and distal nerve compression to improve diagnostic and treatment strategies.
Methods: The PearlDiver database was retrospectively queried from 2010 to 2022 for patients with concurrent lower extremity proximal and distal compressive symptoms using International Classification of Diseases (ICD)-9/10 diagnostic codes and Current Procedural Terminology (CPT) codes. The incidence was calculated from the percentage of surgically treated patients with concomitant ICD/CPT codes relative to the total population.
Results: Of the 652 patients that met the study criteria, the majority were female (59.2%) with an average age of 54.63 years, and the highest incidence was in the 55-59 age group. The average treatment cost for DCS was $3,617.18. The most frequent ICD code among suspected DCS cases was thoracic or lumbosacral neuritis or radiculitis (n=72,678). Tarsal tunnel decompression was the most common procedure performed (n=444). Diagnostic radiology and pain medicine specialties led in diagnosing, while neurosurgery and orthopedic surgery managed most treatments. Regionally, the South reported the highest DCS incidence in the United States.
Conclusion : The incidence of lower extremity DCS was 0.05%. Although this rate is low, diagnostic delays can lead to increased costs and prolonged patient discomfort. A clearer understanding of lower extremity DCS is essential to establish efficient diagnostic criteria, improve care timeliness, reduce unnecessary interventions, and ultimately support patients’ mobility and quality of life. This study underscores the need for further research to improve patient outcomes and reduce costs associated with delayed diagnosis of lower extremity DCS.
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