Double Crush Syndrome in the Lower Extremity: Peroneal Decompression After Lumbar Decompression Leads to Improved Clinical Outcomes

Introduction: Double crush syndrome (DCS) is defined as multiple sites of compression along a single nerve that results in compound nerve dysfunction. To date, no optimal treatment paradigm has been established for this unique clinical entity. We present a retrospective series of 31 DCS patients, with peroneal neuropathy and L5 radiculopathy, that underwent lumbar decompression followed by peroneal decompression to elucidate clinical outcomes of this sequential management.

Methods: A retrospective analysis of 31 consecutive patients who underwent a peroneal decompression for peroneal neuropathy following a prior lumbar decompression for L5 radiculopathy between January 2000 and April 2023 at two quaternary academic institutions was performed. Descriptive statistics of patient demographics, clinical presentation, surgical details and outcomes were performed at 4 timepoints: pre-lumbar decompression, post-lumbar decompression, pre-peroneal decompression, and post-peroneal decompression.

Results: The mean age of patients was 66.48 years old, ranging from 47 to 80 years old. 17 patients had peroneal entrapment on the right, while 14 had entrapment on the left. Pre-lumbar decompression, average dorsiflexion strength was 3.00 out of 5 and improved to 4.3 post-lumbar decompression. As these patients returned with recurrent or worsening symptoms however, mean dorsiflexion strength returned to 3.00 out of 5. Post-peroneal decompression, mean dorsiflexion strength improved to 3.87. Pre-lumbar decompression, 92% of patients had pain or numbness, or both, in the lateral leg/dorsal foot, which decreased to 58% post-lumbar decompression. 92% of patients subsequently reported continued or recurrent pain or numbness, or both, in the lateral leg/dorsal foot, decreasing to 50% post-peroneal decompression.

Conclusion : This is the first series to report outcomes for DCS patients undergoing peroneal decompression following a prior spine surgery for continued or recurrent clinical symptoms. Peroneal decompression was found to improve average dorsiflexion strength and should be considered if patients fail to achieve sufficient improvement or have recurrent symptoms following spine surgery.