European Spine Journal

, Volume 13, Issue 1, pp 32–37 | Cite as

Outcomes of decompression surgery for lumbar spinal stenosis in elderly diabetic patients

  • Zeev Arinzon
  • Abraham Adunsky
  • Zeev Fidelman
  • Reuven Gepstein
Original Article

Abstract

The purpose of this study was to assess and compare the outcome of surgical decompression for spinal stenosis in diabetic and non-diabetic elderly patients. This is a retrospective chart analysis conducted in a university affiliated referral hospital. The participants were consecutive patients, age 65 and older, undergoing laminectomy for spinal stenosis during 1990–2000. We assessed patients’ clinical and demographic data, procedures, perioperative complications, preoperative and postoperative pain intensity, basic activities of daily living (BADL), patients’ satisfaction, the need for repeated surgery, and overall mortality. A total number of 62 elderly diabetic group (DG) patients undergoing decompression surgery for spinal stenosis were compared with a sex and age-matched non-diabetic control group (CG) at baseline, and a mean of 40.3 months thereafter. We found that the DG patients had more pain (p=0.042), and suffered more frequently from neurogenic claudication (p=0.0018), motor weakness (p=0.021) and numbness of the affected limb (p=0.0069) than the CG patients. Nocturnal pain was reported in 24% of the DG patients. Pain relief was successfully achieved in both groups (p<0.001), but the patients’ satisfaction was greater in the non-diabetic patients (p=0.0067). Revision surgery was more frequently performed in the DG than the CG (non-significant difference), and the time interval for such a second intervention was shorter (p=0.04) in the DG. A higher rate of post-operative complications was observed in the DG (p<0.0001). It is concluded that surgical treatment of elderly diabetic patients suffering from spinal stenosis improves BADL and ameliorates pain, but the results remain worse than those observed in non-diabetics. The outcome of diabetic patients depends upon the presence of other comorbidities, concurrent diabetic neuropathy, duration of diabetes and insulin treatment. Successful postoperative pain reduction remained the strongest factor associated with patients’ satisfaction.

Keywords

Diabetes Elderly Laminectomy Spine 

References

  1. 1.
    Airaksinen O, Herno A, Turunen V, Saari T, Suomlainen O (1997) Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22(19):2278–2282CrossRefPubMedGoogle Scholar
  2. 2.
    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24(6):1069–1078PubMedGoogle Scholar
  3. 3.
    Bell DSH, Ward J (2000) Peripheral and cranial neuropathies in diabetes. In: Davidson JK (ed) Clinical diabetes mellitus, 3rd ed, New York, pp 621–635Google Scholar
  4. 4.
    Casten RJ, Parmelee PA, Kleban MH, Lawton MP, Katz IR (1995) The relationship among anxiety, depression and pain in a geriatric institutionalized sample. Pain 61:271–276CrossRefPubMedGoogle Scholar
  5. 5.
    Cinnoti G, Postacchini F, Weinstein J (1994) Lumbar spinal stenosis and diabetes. Outcome of surgical decompression. J Bone Joint Surg Br 76:215–219PubMedGoogle Scholar
  6. 6.
    Diabetes Control and Complications Trial (DCCT) Research Group (1995) Effect of intensive diabetes treatment on nerve conduction in the diabetes control and complications trial. Ann Neurol 38:869–880PubMedGoogle Scholar
  7. 7.
    Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB, Guralnik JM (2000) Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the CHIANTI study. J Am Geriatr Soc 48:1618–1625PubMedGoogle Scholar
  8. 8.
    Greene DA, Stevens MJ, Feldman EL (1999) Diabetic neuropathy: the scope of the syndrome. Am J Med 107(2B):2S-8SCrossRefGoogle Scholar
  9. 9.
    Guralnik JM, Ferrucci L, Simonnsick EM, Salive ME, Wallace RB (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332(9):556–561CrossRefPubMedGoogle Scholar
  10. 10.
    Guralnik JM, Fried LP, Simonsick EM, Kasper JD, Lafferty ME (eds) (1995) The Women’s Health and Aging Study: Health and social characteristics of older women with disability. Bethesda: National Institute of Aging, 1995, NIH Pub. No: 95–4009Google Scholar
  11. 11.
    Harris M, Eastman R, Cowie C (1993) Symptoms of sensory neuropathy in adults with NIDDM in the US population. Diabetes Care 16(11):1446–1452PubMedGoogle Scholar
  12. 12.
    Jonsson B, Annertz M, Sjoberg C, Stromqvist B (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up. Spine 22(24):2938–2944CrossRefPubMedGoogle Scholar
  13. 13.
    Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemke JH, Morris MC, Smith IM (1985) Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc 33(1):23–28PubMedGoogle Scholar
  14. 14.
    Nagler W, Hausen HS (1998) Conservative management of lumbar spinal stenosis. Postgrad Med 103(4):69–89PubMedGoogle Scholar
  15. 15.
    Owens WD, Flets JA, Spitznagel EL (1978) ASA physical status classification: a study of consistency of ratings. Anesthesiology 49:239–243PubMedGoogle Scholar
  16. 16.
    Parmelee PA, Katz IR, Lawton MP (1991) The relation of pain to depression among institutionalized aged. J Gerontol 46:15–21Google Scholar
  17. 17.
    Simpson MJ, 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(12):1823–1829PubMedGoogle Scholar
  18. 18.
    Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17(1):1–8PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Zeev Arinzon
    • 1
    • 2
  • Abraham Adunsky
    • 3
    • 4
  • Zeev Fidelman
    • 1
  • Reuven Gepstein
    • 2
    • 4
  1. 1.Frieda Schiff Warburg Geriatric CenterNetanyaIsrael
  2. 2.Department of Spinal SurgeryMeir General HospitalKfar SabaIsrael
  3. 3.Department of Geriatric RehabilitationSheba Medical CenterTel HashomerIsrael
  4. 4.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

Personalised recommendations