Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients
- 288 Downloads
There have been a few reports on the surgical outcomes of cervical myelopathy in diabetic patients; however, those studies included ossification of the posterior longitudinal ligament. This study investigated whether surgical outcome of expansive laminoplasty (ELAP) for diabetic patients with cervical spondylotic myelopathy (CSM) differs from that for non-diabetic patients and determined prognostic factors in diabetic patients.
We retrospectively reviewed 78 patients with CSM after excluding the cases with other medical conditions, which could affect surgical outcome from 222 consecutive patients who had undergone ELAP between 2000 and 2008 in our hospital. The patients were divided into two groups: diabetic patients (Group 1) and non-diabetic patients (Group 2). We evaluated differences in age, gender, pre- and postoperative Japanese Orthopaedic Association (JOA) score, recovery rate (RR), symptom duration, and postoperative complications between the two groups. In Group 1, the correlation between RR and factors indicating the severity of diabetes mellitus was assessed.
There were 13 patients in Group 1 and 65 in Group 2. There was no significant difference in age, gender, JOA score before or after surgery, or symptom duration between the two groups. Group 1 showed poorer recovery of sensory and motor function in the lower extremities. A negative correlation was observed between RR and the preoperative hemoglobin A1c (HbA1c) level in Group 1.
Diabetic patients experienced benefits from ELAP similar to non-diabetic patients. A negative correlation between RR and preoperative HbA1c level suggests that strict blood sugar control is recommended before surgery.
KeywordsCervical myelopathy Diabetes mellitus Surgical outcome Prognostic factor
This work was presented in part at Eurospine 2009, Warsaw, Poland, October 21–24, 2009 and at the 1st Cervical Spine Research Society Asia Pacific Section, Kobe, Japan, April 24–25, 2010. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
- 1.Chiba K, Ogawa Y, Ishii K, Takaishi H, Nakamura M, Maruiwa H, Matsumoto M, Toyama Y (2006) Long-term results of expansive open-door laminoplasty for cervical myelopathy: average 14-year follow-up study. Spine 31:2998–3005Google Scholar
- 2.Handa Y, Kubota T, Ishii H, Sato K, Tsuchida A, Arai Y (2002) Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis: a retrospective comparison with younger patients. J Neurosurg 96:173–179PubMedCrossRefGoogle Scholar
- 27.Nagashima H, Dokai T, Hashiguchi H, Ishii H, Kameyama Y, Katae Y, Morio Y, Morishita T, Murata M, Nanjo Y, Takahashi T, Tanida A, Tanishima S, Yamane K, Teshima R (2011) Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study. Eur Spine J 20:240–246PubMedCrossRefGoogle Scholar
- 28.Tarsy D, Freeman R (1994) The nervous system and diabetes. In: Kahn CR, Weir GC (eds) Joslin’s diabetes mellitus, 13th edn. Lea and Febiger, Philadelphia, pp 794–816Google Scholar
- 30.Simpson JM, Silveri CP, Balderston RA, Simeone FA, An HS (1993) The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Joint Surg Am 75-A:1823–1829Google Scholar