The effect of concurrent cervical spine degenerative disease on the outcome of rotator cuff repair: a national database study

Abstract

Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears (RCT). This study aimed to investigate relationships between CSD and rotator cuff repair (RCR). A national administrative database (PearlDiver, Colorado Springs, CO) was used to study four patient cohorts: (1)-RCR only (RCRo), (2)-RCR with concurrent cervical spine degenerative disease (RCRC), (3)-RCR after a cervical spine procedure (RCRA), and (4)-RCR before a cervical spine procedure (RCRB). Outcomes of RCR were compared using multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index (ECI), as well as preoperative opioid utilization in the analysis for opioid use. Between 2010 and 2021, 889,977 patients underwent RCR. 784,230(88%) were RCRo. 105,747(12%) were RCRC, of which 21,585(2.4%) had a cervical spine procedure (9670[1.1%] RCRA and 11915[1.3%] RCRB). At 2 years after RCR, compared to RCRo, RCRC had increased risk of surgical site infections (aOR=1.25, p=0.0004), deep vein thrombosis (aOR=1.17, p=0.0002), respiratory complications (aOR=1.19, p=0.0164), ipsilateral shoulder reoperations (débridement [aOR=1.66, p<0.0001], manipulation under anesthesia/arthroscopic lysis of adhesions [aOR=1.23, p<0.0001], distal clavicle excision [aOR=1.78, p<0.0001], subacromial decompression [aOR=1.72, p<0.0001], biceps tenodesis [aOR=1.76, p<0.0001], incision and drainage [aOR=1.34, p=0.0020], synovectomy [aOR=1.48, p=0.0136], conversion to shoulder arthroplasty [aOR=1.62, p<0.0001], revision RCR [aOR=1.77, p<0.0001] and subsequent contralateral RCR [aOR=1.71, p<0.0001]. At 2 years, compared to RCRC patients who did not undergo cervical spine procedure, RCRC patients who had a cervical spine procedure had an increased risk of incision and drainage (aOR=1.50, p=0.0255), conversion to arthroplasty (aOR=1.40, p<0.0001), revision RCR (aOR=1.11, p=0.0374), and lower risk of contralateral RCR (aOR=0.89, p=0.0469). The sequence of cervical spine procedure did not affect the risk of shoulder reoperation. At 1 year, the risk of opioid use after RCR was less for RCRA compared to RCRB patients (aOR=1.71;95%CI 1.61-1.80;p<0.0001 vs. aOR=2.01;95%CI 1.92-2.12;p<0.0001). Concurrent CSD has significant detrimental effects on RCR outcomes. Patients with concurrent CSD undergoing cervical spine procedure similarly have greater risk of ipsilateral shoulder reoperation but decreased risk of contralateral RCR. Risk of prolonged opioid use was lower if RCR followed cervical spine procedure. Concurrent CSD must be considered and possibly treated to optimize the outcome of RCR.