Persistent Shoulder Pain After Anterior Cervical Discectomy and Fusion (ACDF): Another Dual Pathology

Abstract

Purpose It is often difficult for the clinician to isolate the etiology of pain occurring either in the neck or shoulder because of the reason that neck pain can refer to the shoulder and vice versa. Concordance research has found that around one in 10 patients who were referred for cervical radiculopathy had comorbid shoulder pathology. The goal of this research is to analyze and correlate risk factors for persistent shoulder pain (non-dermatomal) following cervical spine surgery. Methods This was a single-center, retrospective study. The medical records of patients admitted for anterior cervical discectomy and fusion (ACDF) were reviewed from August 2018 to Feb 2021. Patients of both sexes and age more than 18 years who underwent ACDF (single/multiple levels) were included and the medical record was checked for whether they had persistent shoulder pain following ACDF. The proportion of patients undergoing shoulder surgery for associated rotator cuff tears and subacromial impingement were recorded. Results Seventy patients presenting with cervical prolapsed intervertebral disc (PID) were studied. A majority of our patients were females (n=48, 68.6%) and males (n=22, 31.4%) with an M:F ratio of 1:2 and the majority of patients were between the ages of 40 to 60 years (n=34, 48.6%). After surgical intervention (ACDF), 48 patients (68.6%) noted the cessation of shoulder symptoms (pain, weakness, and numbness) during their last visit. Rotator cuff tear (supraspinatus mainly) was the predominant finding in MRI in those who didn't improve after ACDF (n=18, 25.7%, p-value: 0.001). Twenty patients (28.6%) underwent acromioplasty and rotator cuff tendon repair and four patients responded well to subacromial injection. The C6-7 level was most commonly affected (n=48, 68.6%) followed by C5-6 level (n=19, 27.1%). No significant association was found between cervical levels with shoulder pathologies (p-0.171), though a significant association between a visual analog scale (VAS) score >7 after surgery with shoulder pathologies (p-0.001) was found. The C6-7 level was commonly affected in females (p=0.038) but no significant association between gender and shoulder pathologies was found (p=0.332). Conclusion Dual pathologies in patients with cervical PID are very common. It needs careful attention by doing thorough clinical examination and correlating patient symptoms with radiological investigations. A patient who presents with persistent shoulder pain after cervical spine surgery had a higher chance of having concurrent shoulder pathology, and they should be properly investigated and managed to alleviate the suffering of the patient.

Keywords: acdf; dual pathologies; rotator cuff tears.

Figure 1. Type of shoulder pathologies