Clinical outcomes of total shoulder arthroplasty in patients with prior cervical fusion.

BACKGROUND

Cervical spine pathology frequently coexists with shoulder pathology, which may contribute to referred pain and muscle weakness that can compromise shoulder function. This study aimed to evaluate clinical outcomes of patients with prior cervical fusion undergoing total shoulder arthroplasty (TSA).

METHODS

A retrospective review of prospectively collected data was performed for patients undergoing anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) by 2 fellowship-trained shoulder surgeons between 2017 and 2023. Patients with a history of cervical fusion were matched 1:1 with controls without prior fusion based on age, sex, body mass index, preoperative diagnosis, and procedure. Outcomes included visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and range of motion (ROM), assessed preoperatively and at a minimum 24 months follow-up. Independent and paired t-tests were used for comparisons, with significance defined as P < .05.

RESULTS

A total of 112 patients were included (56 with prior cervical fusion, 56 controls), including 26 aTSA patients (n = 13 per group) and 86 rTSA patients (n = 43 per group). Across the entire cohort, both groups achieved significant improvement in pain and function from baseline (all P < .001). No differences were observed in postoperative visual analog scale (1.78 vs. 1.15, P = .128), ASES (76.2 vs. 80.4, P = .254), SST (8.2 vs. 9.0, P = .222), or ROM outcomes (all P > .05). The magnitude of improvement was also comparable between groups. In the aTSA subgroup, patients with prior cervical fusion achieved significantly lower postoperative ASES (76.3 vs. 91.7, P = .038) and SST scores (8.1 vs. 11.2, P = .025), though preoperative to postoperative improvements were not significantly different (ASES P = .426, SST P = .259). In the rTSA subgroup, no differences were observed in the improvement of pain, function, or ROM.

CONCLUSION

Prior cervical fusion was not associated with inferior outcomes following TSA at short-term follow-up. Although patients with cervical fusion undergoing aTSA demonstrated lower absolute postoperative functional scores, their improvements were comparable to controls.