The operative treatment of shoulder pain in patients with a concurrent diagnosis of cervical spondylosis and shoulder dysfunction

Ajith Malige, Paul N. Morton, Gregory F. Carolan, Gbolabo Sokunbi


Background: Etiology of neck and shoulder pain may be multifactorial. When surgical intervention is indicated, the choice of whether to start with spine or shoulder surgery is an important clinical decision to make based on severity of pathologies, comorbidities, and patient preference. The literature includes with very few studies exploring the incidence or results of the surgical treatment paths followed in this clinical situation. This study compares patient-reported outcomes of patients with both cervical spine and shoulder pathology who underwent intervention for cervical, shoulder, or both pathologies.
Methods: The authors retrospectively reviewed 154 charts at a single institution between 2009–2017 who had both cervical spine and shoulder pathology while undergoing operative intervention of one or both pathologies. For each patient, demographics, patient-perceived success, NRS pain scores, functional outcomes (Focus on Therapeutic Outcome scores and neck disability index scores), and post-operative opioid use were reported.
Results: Patient-reported success (P=0.85), NRS pain score decreases (P=0.45), all functional outcomes except for final external rotation range of motion (P=0.02), and post-operative opioid use (P=0.30) were similar when comparing only cervical spine to shoulder intervention. Success (P=1.00), NRS pain score decreases (P=0.37), both functional outcomes, and post-operative opioid use (P=0.08) were all similar when comparing patients who underwent cervical then shoulder intervention to shoulder then cervical intervention. Finally, statistical significance was found when comparing reported success (P=0.0004) but not NRS decreases (P=0.18), functional outcomes, or post-operative opioid use (P=0.43) in patients who underwent both operation types versus only one.
Conclusions: Similar outcomes are seen when comparing isolated surgical intervention types and order of surgeries when undergoing both interventions. Multiple surgical intervention types, regardless of order, tends to result in higher rates of patient-reported success but similar post-operative outcomes compared to one.