Concurrent Cervical Spine Pathology is Associated with No Clear Difference in Clinical Outcomes, but Increased Complication Rates Following Shoulder Surgery: A Systematic Review.

Purpose: This systematic review aimed to assess the impact of prior or concurrent cervical spine pathology on clinical outcomes following shoulder surgery.

Methods: A systematic literature search was performed of the MEDLINE, Embase, and Cochrane databases. The inclusion criteria were English-language studies with Level IV evidence or greater in which shoulder outcomes data were stratified according to whether patients previously had a documented cervical spine procedure or pathology. Eligible studies were categorized based on the type of shoulder procedure performed. The directionality and magnitude of impact of prior cervical spine pathology on clinical outcomes following shoulder surgery were summated.

Results: Among 129 unique studies identified, 9 studies were included for analysis. All included studies were level III evidence. Six studies reported outcomes pertaining to arthroscopic shoulder surgeries, and three studies reported outcomes pertaining to shoulder arthroplasty. Eight studies included patients who had a history of prior or subsequent cervical spine surgery, while one study evaluated patients with a diagnosis of a cervical spine condition. Five of 9 studies found either inferior postoperative patient-reported outcomes (PROs) or increased perioperative complications, with one study reporting decreased minimal clinically important difference (MCID) and substantial clinical benefit (SCB) attainment. No studies reported improved shoulder outcomes, complications rates, or MCID/SCB attainment. These findings were consistent regardless of how cervical pathology was defined (surgical or non-surgical). The sequence of shoulder and cervical spine surgery was not associated with differences in PROs or perioperative complication rate following shoulder surgery.

Conclusions: Patients undergoing shoulder surgery with a history of a cervical spine condition have increased rates of surgical complications and mixed, but consistently non-superior PROs compared to patients without dual shoulder-cervical spine pathology. The sequence of undergoing shoulder and cervical spine surgery was not associated with clinical outcomes following shoulder surgery.

Level Of Evidence: Level III, Systematic Review of Level III studies.