JSES - 2026-03-19 - Journal Article
Clinical Outcomes of Total Shoulder Arthroplasty in Patients with Prior Cervical Fusion.
Stephens SP, Rohl MR, Hall B, Manes TJ, Eichenseer PH, Badman BL
Topics
Key Takeaway
Prior cervical fusion did not reduce the magnitude of functional improvement after TSA, though aTSA patients with prior fusion had lower absolute postoperative ASES scores (76.3 vs. 91.7, p=0.038) compared to matched controls.
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Summary
This matched retrospective study compared TSA outcomes in 56 patients with prior cervical fusion versus 56 controls matched for age, sex, BMI, diagnosis, and procedure type. Both groups achieved significant improvement in VAS, ASES, SST, and ROM from baseline (all p<0.001), with no between-group differences in the overall cohort. In the aTSA subgroup (n=13 per group), prior fusion patients had lower absolute postoperative ASES (76.3 vs. 91.7, p=0.038) and SST (8.1 vs. 11.2, p=0.025), but magnitude of improvement was equivalent; no differences were found in the rTSA subgroup.
Key Limitation
The aTSA subgroup of 13 patients per arm is critically underpowered, making the statistically significant absolute score differences unreliable and the non-significant improvement comparisons potentially false negatives.
Original Abstract
INTRODUCTION
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 two 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, BMI, preoperative diagnosis, and procedure. Outcomes included Visual Analog Scale (VAS) 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<0.05.
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<0.001). No differences were observed in postoperative VAS (1.78 vs. 1.15, p=0.128), ASES (76.2 vs. 80.4, p=0.254), SST (8.2 vs. 9.0, p=0.222), or ROM outcomes (all p>0.05). 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=0.038) and SST scores (8.1 vs. 11.2, p=0.025), though preoperative to postoperative improvements were not significantly different (ASES p=0.426, SST p=0.259). 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.