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Diabetes mellitus as a risk factor for intervertebral disc degeneration: a critical review

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Abstract

Purpose

To examine to what extent diabetes mellitus (DM) is implicated as a distinct mechanism in intervertebral disc degeneration (IVDD).

Methods

The published clinical and laboratory data relevant to this matter are critically reviewed. A total of 12 clinical studies evaluate the association between DM and degenerative changes such as IVDD, spinal stenosis (SS) and IVD herniation. A total of 34 laboratory research papers evaluate the association between DM and IVDD.

Results

There are 7 studies that correlate DM with IVDD, 4 of them showing that DM is a significant risk factor for degeneration, and 3 of them failing to establish any association. Three studies demonstrate significant association between DM and SS. However, 2 of these studies also include patients with IVD herniation that failed to demonstrate any correlation with DM. Two other studies indicate a significant association between DM and lumbar disc herniation. Multiple different mechanisms, acting independently or interactively, cause tissue damage leading to IVDD including: microangiopathy of the subchondral vertebral endplate, cellular senescence, cell death (through apoptosis or autophagy), hyperglycaemia, advance glycation end products, adipokines, and cytokines (through oxidative, osmotic, and inflammatory mechanisms).

Conclusion

The clinical evidence is not consistent, but weakly supports the relationship between DM and IVDD. However, the laboratory studies consistently suggest that DM interferes with multipronged aberrant molecular and biochemical pathways that provoke IVDD. Taken as a whole, the strong laboratory evidence and the weak clinical studies implicate DM as a distinct contributing factor for IVDD.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, Venizeleio General Hospital of Heraklion, Crete, Greece

    Kalliopi Alpantaki

  2. Department of Trauma Surgery, Orthopaedics and Spinal Surgery RMK Kliniken Schorndorf, Schorndorf, Germany

    Alkisti Kampouroglou

  3. Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Athens, Greece

    Christos Koutserimpas

  4. Department of Medical Endocrinology PE 2132, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Grigoris Effraimidis

  5. Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA

    Alexander Hadjipavlou

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  1. Kalliopi Alpantaki
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Alpantaki, K., Kampouroglou, A., Koutserimpas, C. et al. Diabetes mellitus as a risk factor for intervertebral disc degeneration: a critical review. Eur Spine J 28, 2129–2144 (2019). https://doi.org/10.1007/s00586-019-06029-7

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