Malige Ajith, Morton Paul N, Carolan Gregory F, Sokunbi Gbolabo
St. Luke's University Health Network, Bethlehem, PA, USA.
J Spine Surg. 2019 Jun;5(2):207-214. doi: 10.21037/jss.2019.04.18.
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.
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.
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.
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.
颈肩痛的病因可能是多因素的。当需要进行手术干预时，基于病变的严重程度、合并症和患者偏好，决定是先进行脊柱手术还是肩部手术是一项重要的临床决策。文献中很少有研究探讨在这种临床情况下所采用的手术治疗路径的发生率或结果。本研究比较了患有颈椎和肩部病变且接受了颈椎、肩部或两者病变干预的患者的患者报告结局。
作者回顾性分析了2009年至2017年间在单一机构接受手术干预的154例同时患有颈椎和肩部病变的患者病历。报告了每位患者的人口统计学信息、患者感知的成功率、数字评分量表疼痛评分、功能结局（治疗结局重点评分和颈部残疾指数评分）以及术后阿片类药物使用情况。
仅比较颈椎干预和肩部干预时，患者报告的成功率（P = 0.85）、数字评分量表疼痛评分降低（P = 0.45）、除最终外旋活动范围外的所有功能结局（P = 0.02）以及术后阿片类药物使用情况（P = 0.30）相似。比较先进行颈椎干预然后肩部干预的患者与先进行肩部干预然后颈椎干预的患者时，成功率（P = 1.00）、数字评分量表疼痛评分降低（P = 0.37）、两种功能结局以及术后阿片类药物使用情况（P = 0.08）均相似。最后，比较接受两种手术类型的患者与仅接受一种手术类型的患者时，在报告的成功率方面发现有统计学意义（P = 0.0004），但在数字评分量表疼痛评分降低（P = 0.18）、功能结局或术后阿片类药物使用情况（P = 0.43）方面未发现统计学意义。
比较单独的手术干预类型以及进行两种干预时的手术顺序时，会观察到相似的结局。与单一手术干预相比，多种手术干预类型，无论顺序如何，往往会导致患者报告的成功率更高，但术后结局相似。
