Total shoulder arthroplasty in patients with degenerative cervical spine disease: Does cervical spine surgery affect outcomes?

Abstract

Rates of both total shoulder arthroplasty (TSA) and cervical spine surgery for degenerative cervical spine disease (DCSD) are increasing. However, it is still unknown if prior cervical spine surgery for DCSD impact outcomes following TSA. This study aims to compare the risk of complications and revisions in patients undergoing TSA with DCSD between patients with and without prior cervical spine surgery. This study is a retrospective review of the PearlDiver Mariner Database. Based on whether or not patients had prior cervical spine surgery, the patients with DCSD and undergoing TSA were divided into 2 groups: patients with DCSD and cervical spine surgery, and patients with DCSD and without cervical spine surgery. The two groups were matched based on age, gender, the Charlson comorbidity index (CCI), and obesity. Surgical complications and revisions with regards to their TSA at 1 through 5 years post-operatively were compared between the groups. The TSA with DCSD and no cervical spine surgery cohort were older (63.7 ± 8.4 vs 61.2 ± 8.4 years, p < .001), had higher CCI (1.2 ± 1.7 vs 1.0 ± 1.6, p < .001), had a higher proportion of males (47.8% vs 41.8%, p = 0.01), and had a lower % of patients with obesity (50.9% vs 53.3%, p = 0.01). After matching, 2899 patients remained in each group. The group with prior cervical spine surgery had higher rates of mechanical loosening at 5 years post-operatively (1.2% vs 1.8%, p = 0.05), and lower rates of periprosthetic fractures at 3 and 4 years post-operatively (0.4% vs < 10, p = 0.01; 0.5% vs < 10, p = 0.02 respectively). No difference in the remaining surgical complications or revisions was seen between the two groups. This study highlights an increase in risk of mechanical loosening after TSA in patients with prior cervical spine surgery. Additionally, patients with DCSD without prior cervical spine surgery had an increased risk of sustaining periprosthetic fractures after TSA, potentially due to untreated myelopathy and related falls.