Concomitant Cervical Spine Disease Worsens PROMIS Outcomes in Patients Undergoing Arthroscopic Rotator Cuff Repair.

Abstract

Background: Rotator cuff disease is one of the most common causes of shoulder disability. Pathologic conditions of the shoulder are often complicated by concomitant conditions such as cervical spine (C-spine) disease.

Purpose/hypothesis: The purpose of this article is to assess whether patients with concomitant C-spine disease undergoing arthroscopic rotator cuff repair (ARCR) demonstrate lower absolute values in Patient-Reported Outcomes Measurement Information System (PROMIS) scores compared with those without C-spine disease and whether it affects the achievement of the minimal clinically important difference (MCID). It was hypothesized that patients with C-spine disease undergoing ARCR demonstrate lower absolute values in PROMIS scores compared with those without concomitant C-spine disease, but those patients experience a similar improvement and achievement of MCID after ARCR surgery.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 1387 patients who underwent ARCR at a single institution were identified. A retrospective chart review of a prospectively collected database was conducted to capture PROMIS Pain Interference (PI), Physical Function (PF), and Depression (Dep) scores. Patients were stratified into 2 groups based on the presence of concomitant C-spine disease at the time of surgery. The MCID was calculated using a distribution-based methodology.

Results: Of the total, 528 patients met inclusion criteria for final analysis, 120 of whom had concomitant C-spine disease. Unadjusted analysis of descriptive variables revealed no significant differences between the C-spine and control groups. Both cohorts showed significant improvement at final follow-up compared with their preoperative PROMIS values for PF, PI, and Dep (P < .001). Compared with patients without it, those with concomitant C-spine disease had statistically worse preoperative PROMIS scores for PI (62.6 ± 6.8 vs 60.1 ± 6.8; P = .001), Dep (50.4 ± 9.8 vs 47.6 ± 9.8; P = .004), and PF scores (39.5 ± 7.3 vs 42.6 ± 8.4; P = .001), as well as worse postoperative scores for PI (53.9 ± 7.9 vs 50.5 ± 8.1; P = .001), Dep (43.4 ± 9.4 vs 41.1 ± 7.8; P = .003), and PF (45.6 ± 7.6 vs 48.6 ± 7.9; P = .001). Notably, these differences while statistically significant were not clinically significant due to the overlap between the C-spine and control group PROMIS scores in each domain. No significant difference was found in the achievement of MCID between the 2 groups for PF, PI, or Dep. Regression analysis revealed that C-spine disease was not a significant predictor of achievement of MCID in any of the 3 PROMIS domains.

Conclusion: This study underscores the broad applicability of ARCR for patients with complex musculoskeletal pathology such as concomitant C-spine disease. The findings highlight the importance of setting expectations for patients regardless of their concomitant C-spine pathology before surgery.