Lumbosacral double crush syndrome

Lumbosacral double crush syndrome is a condition of additive nerve dysfunction in the setting of a combination of a compressive proximal lesion and a distal peripheral entrapment mononeuropathy. This is a potentially under-recognized and undertreated syndrome that may be responsible for some "failed" spine or peripheral nerve surgeries, a situation in which patients experience ongoing symptoms despite seemingly appropriate surgical management. Prevalence data are limited, but there exists literature to suggest that up to 5-10% of patients with a compressive lumbosacral radiculopathy have a second peripheral nerve lesion. Therefore, the surgeon must maintain a high index of clinical suspicion when evaluating patients for lumbosacral and/or peripheral nerve entrapments, particularly in individuals with persistent symptoms despite prior surgical spine and/or peripheral nerve decompression. A detailed physical examination and judicious use of electrodiagnostic and imaging studies are critical to timely diagnosis, as is multidisciplinary participation. If the decision is made to intervene surgically, there must be a detailed discussion with the patient about expectations, as well as the order in which to address the multiple sites of compression. Improving awareness and understanding of the double crush syndrome will improve treatment decisions and ultimately lead to better clinical outcomes in both spine and peripheral nerve surgery.