Khan Shahbaz, Hameed Nida, Mazar Saddam, Hashmi Imtiaz A, Rafi Mohammad S, Shah Mohammad Idrees, Baloch Nadeem A
Orthopedics and Spine Surgery, Ziauddin University Hospital, Karachi, PAK.
Orthopedics and Traumatology, Dr. Ziauddin Hospital, Karachi, PAK.
Cureus. 2021 Mar 5;13(3):e13709. doi: 10.7759/cureus.13709.
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.
目的 由于颈部疼痛可牵涉至肩部，反之亦然，临床医生常常难以确定颈部或肩部疼痛的病因。一致性研究发现，在因颈椎神经根病转诊的患者中，约十分之一患有合并的肩部病变。本研究的目的是分析并关联颈椎手术后持续性肩部疼痛（非皮节性）的危险因素。方法 这是一项单中心回顾性研究。回顾了2018年8月至2021年2月因颈椎前路椎间盘切除融合术（ACDF）入院患者的病历。纳入接受ACDF（单节段/多节段）手术、年龄超过18岁的男女患者，并检查病历以确定他们在ACDF后是否有持续性肩部疼痛。记录因相关肩袖撕裂和肩峰下撞击而接受肩部手术的患者比例。结果 研究了70例表现为颈椎间盘突出症（PID）的患者。我们的大多数患者为女性（n = 48，68.6%）和男性（n = 22，31.4%），男女比例为1:2，大多数患者年龄在40至60岁之间（n = 34，48.6%）。手术干预（ACDF）后，48例患者（68.6%）在最后一次就诊时肩部症状（疼痛、无力和麻木）消失。在ACDF后未改善的患者中，肩袖撕裂（主要是冈上肌）是MRI中的主要发现（n = 18，25.7%，p值：0.001）。20例患者（28.6%）接受了肩峰成形术和肩袖肌腱修复，4例患者对肩峰下注射反应良好。C6 - 7节段最常受累（n = 48，68.6%），其次是C5 - 6节段（n = 19，27.1%）。虽然未发现颈椎节段与肩部病变之间存在显著关联（p = 0.171），但发现术后视觉模拟量表（VAS）评分>7与肩部病变之间存在显著关联（p = 0.001）。C6 - 7节段在女性中更常受累（p = 0.038），但未发现性别与肩部病变之间存在显著关联（p = 0.332）。结论 颈椎PID患者的双重病变非常常见。需要通过全面的临床检查并将患者症状与影像学检查相关联来仔细关注。颈椎手术后出现持续性肩部疼痛的患者并发肩部病变的可能性更高，应对他们进行适当的检查和处理以减轻患者的痛苦。
