Double Crush Syndrome of the Lower Limb in L5 Radiculopathy and Peroneal Neuropathy: A Case Report

Double crush syndrome (DCS) is a clinical condition involving impingement of the spinal and peripheral nerves. DCS of the lower limbs has been recognized; however, no detailed reports have been published. Herein, we report a rare case of the coexistence of L5 radiculopathy and peroneal nerve entrapment neuropathy. The patient suffered from pain in the left lower leg and left foot combined with muscle weakness in the left leg without a Tinel-like sign in the peroneal tunnel area. MRI showed a deficit in the left L5 nerve root sleeve, and X-ray imaging revealed L5 spondylolysis. Lumbar fusion surgery was performed at L5-S1. Subsequently, the patient’s symptoms were partially improved, but the pain and toe and ankle motor weakness persisted. In addition, a Tinel-like sign appeared at the entrapment point of the peroneal nerve. The entrapped peroneal nerve was decompressed, and the patient’s symptoms improved. The patient had L5 radiculopathy owing to the improvement in his symptoms in the upper leg before and after lumbar surgery. It is unclear why no Tinel-like sign was detected before the first surgery, but we hypothesized that L5 nerve disorder may mask the symptoms triggered by compression of the peroneal nerve due to the complex pathology of DCS and dynamic factors. Distinguishing between radiculopathy and relative peripheral neuropathy should always be a consideration. DCS may mask characteristic symptoms, and it is important to carefully follow up the patient to detect changes in his or her condition.