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

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.

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.

Cohort study; Level of evidence, 3.

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.

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.

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.