{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:51:37Z","timestamp":1786704697245,"version":"build-2736575974"},"reference-count":10,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003621","name":"Ministry of Science, ICT and Future Planning","doi-asserted-by":"publisher","award":["2014M3C1B2048422"],"award-info":[{"award-number":["2014M3C1B2048422"]}],"id":[{"id":"10.13039\/501100003621","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To define risk factors of having persistent shoulder pain following cervical spine surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From April 1995 to May 2012, 862 patients underwent cervical spine surgery in a tertiary referral university hospital. Ninety\u2010six patients were referred to a shoulder surgeon for persistent shoulder pain over 3\u2009months after cervical spine surgery. Thirty\u2010five were excluded from the study due to failure to follow\u2010up or lack of radiographic data. We analyzed a total of 61 patients as patient group (PG) compared to age, sex, and surgeon matched control group (CG) with no shoulder pain after surgery. Medical records were reviewed for age, sex, level of cervical surgery, approach of cervical surgery, underlying medical problems, final diagnosis of the shoulder pathology, and shoulder visual analog scale (VAS) score. The pre\u2010 and post\u2010operative variables for level of cervical surgery, approach of cervical surgery, underlying medical history, and shoulder VAS were compared and analyzed in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The number of patients with lower cervical level surgery was significantly higher (91 patients, 74.6%) compared to upper cervical level surgery (31 patients, 25.4%) (<jats:italic>P<\/jats:italic> = 0.005). Anterior approach was more frequently used (70 patients, 57.3%) compared to posterior approach (52 patients, 42.7%) (<jats:italic>P<\/jats:italic> &lt; 0.001). The final diagnosis of shoulder pathology in PG were rotator cuff disease in 31 patients, adhesive capsulitis in 18 patients, and calcific tendinitis in 10 patients respectively. No significant difference for preoperative shoulder VAS score was found in both groups. A lower level of cervical spine pathology in patients (C<jats:sub>4<\/jats:sub>\u2010T<jats:sub>1<\/jats:sub> level) and posterior approach surgery were factors that significantly presented with more shoulder pain. Subgroup analysis revealed no statistical difference for level of cervical surgery and approach of cervical surgery among groups with different shoulder pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current study includes patients with persistent shoulder pain following cervical surgery without having evidence of concurrent preexisting shoulder pathology documented previously. We suggest that posterior approach and lower level of cervical surgery patients could be clinically relevant risk factors for persistent shoulder pain following cervical spine surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12531","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T00:57:43Z","timestamp":1572397063000},"page":"845-849","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk Factors for Persistent Shoulder Pain After Cervical Spine Surgery"],"prefix":"10.1111","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4326-8205","authenticated-orcid":false,"given":"Erica","family":"Kholinne","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery St. Carolus Hospital  Jakarta Indonesia"},{"name":"Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine University of Ulsan  Ulsan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae\u2010Man","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine University of Ulsan  Ulsan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yucheng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine University of Ulsan  Ulsan South Korea"},{"name":"Department of Hand Surgery, Affiliated Hospital of Nantong University Nantong, Nantong University  Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun\u2010Joo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kyungpook National University Hospital  Daegu South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6181-9621","authenticated-orcid":false,"given":"Kyoung Hwan","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine University of Ulsan  Ulsan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u2010Ho","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine University of Ulsan  Ulsan South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,29]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199006000-00004"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1278-8"},{"key":"e_1_2_5_4_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/00003086-199009000-00017","article-title":"Cervical spine and shoulder pain","volume":"258","author":"Hawkins RJ","year":"1990","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31815cda83"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199609010-00005"},{"key":"e_1_2_5_7_1","first-page":"170","article-title":"Neck and shoulder pain: differentiating cervical spine pathology from shoulder pathology","volume":"18","author":"Pateder DB","year":"2009","journal-title":"J Surg Orthop 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