The relationship between diffusion tensor imaging and the clinical classification of cubital tunnel syndrome.

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Abstract

[Indexed for MEDLINE] 17. Eur Spine J. 2026 Apr;35(4):2180-2186. doi: 10.1007/s00586-025-09291-0. Epub 2025 Aug 29. Order of surgical intervention in double-crush syndrome. Holloway M(1), Cady-McCrea C(2), Carroll T(2), Wilbur D(2), Molinari R(2). Author information: (1)University of Rochester Medical Center, Rochester, United States. melissa_holloway@urmc.rochester.edu. (2)University of Rochester Medical Center, Rochester, United States. BACKGROUND: Double-crush syndrome involves concurrent nerve compression at two points, typically in the cervical spine and peripherally in the upper extremity, such as the ulnar nerve at the elbow or the median nerve at the wrist. Surgical management of this condition, including which decompression to perform first, remains controversial. We aim to explore the effect of surgical technique, timing, and relative order on outcomes in patients with combined cervical and peripheral upper extremity nerve compression. METHODS: This retrospective study included adult patients treated at a Level 1 trauma center between 2015 and 2022. All patients underwent primary cervical decompression and either carpal tunnel release, cubital tunnel release, or both, with open and endoscopic procedures included. Collected data included patient demographics, electrodiagnostic findings, surgical dates, and postoperative PROMIS scores (Physical Function [PF], Pain Interference [PI], and Depression [D]) collected over a minimum 6-month follow-up. We compared outcomes based on whether cervical decompression or peripheral nerve decompression was performed first. Multivariable logistic regression assessed the impact of surgical order and other factors on achieving the minimal clinically important difference (MCID) in PROMIS scores. RESULTS: Patients who underwent cervical spine decompression first showed significantly better outcomes in PROMIS PF and D categories at multiple postoperative time points, including 1 month (PF, p = 0.03; D, p = 0.02), 6 months (PF, p = 0.02; D, p