Jeremy Tran, n/a: No financial relationships to disclose
Introduction: Neuropathic upper extremity pain is a common neurologic condition with possible etiologies to include central nerve compression in the cervical spine or peripheral nerve compression, such as carpal and cubital tunnel syndromes. The overlapping and sometimes concurrent clinical manifestations of these entities can make determining the exact etiology of pain challenging and may complicate treatment. Without knowing for certain which is the source of their symptoms, patients can be subject to costly, and sometimes unnecessary, surgeries. However, if surgeons fail to recognize when their patient’s pain is due to multiple contributing factors, they may be inadequately treated.
Objectives: To investigate temporal patterns in surgical treatment of patients who underwent cervical spine decompression surgery (CSD) and later required either carpal tunnel release (CTR) or cubital tunnel release (CuTR), as well as the opposite series of surgeries.
Methods: The Military Health System Data Repository, consisting of medical treatment data of all active duty servicemembers, dependents, and retired beneficiaries, was queried for common procedural terminology (CPT) codes for CSD, CTR, and CuTR between October 2016 and December 2022. Patients were divided into 5 categories based on sequence of surgical intervention: 1) CSD before CTR, 2) CSD before CuTR, 3) CTR before CSD, 4) CuTR before CSD, and 5) concurrent CSD and CTR/CuTR. The percentage of patients in each category was calculated, as well as the time between surgeries. Any revision surgeries were also documented, and their occurrence rates were calculated.
Results: Of 326 total patients who underwent both cervical spine nerve decompression and carpal or cubital tunnel decompression, 118 underwent CSD prior to CTR (36.2%, mean time between surgeries 536.8 ± 438.0 days), 63 underwent CSD prior to CuTR (19.3%, 496.6 ± 425.5 days), 82 underwent CTR prior to CSD (25.1%, 538.0 ± 484.0 days), 41 underwent CuTR prior to CSD (12.6%, 479.3 ± 421.6 days), and 22 underwent concurrent CSD and CTR/CuTR. Mean time between surgeries was not significantly different across groups (single-factor ANOVA, p=0.85). In patients who underwent initial CSD (n=181), 16 required CSD revision (8.8%), 3 CuTR revision (1.7%), and 1 CTR revision (0.6%). In patients who underwent initial CTR (n=82), 7 required CTR revision (8.5%) and 2 CSD revision (2.4%). For patients who underwent an initial CuTR (n=41), 1 required CuTR revision (2.4%) and 1 CSD revision (2.4%). No patients who underwent concurrent CSD and CTR/CuTR required revision surgery.
Conclusions: The most common series of surgeries for patients who underwent both CSD and CTR/CuTR within a 6-year period was CSD followed by CTR. The most frequent revision surgery was revision CSD following an initial cervical spine decompression.
