Asian Spine J.  2019 Jun;13(3):468-477. 10.31616/asj.2018.0082.

Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

• Tanishima
• Mihara T
• Tanida A
• Takeda C
• Murata M
• Takahashi
• Yamane K
• Morishita
• Morio Y
• Ishii H
• Fukata S
• Nanjo Y
• Hamamoto Y
• Dokai T
• Nagashima

• KMID: 2449802
• DOI: http://doi.org/10.31616/asj.2018.0082

Abstract

STUDY DESIGN: Multicenter, prospective study. PURPOSE: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. OVERVIEW OF LITERATURE: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes.
METHODS
The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables.
RESULTS
JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group.
CONCLUSIONS
Poor glycemic control might prevent postoperative functional recovery of the spinal cord.

Keyword

Neck; Spinal cord compression; Diabetes mellitus; Treatment outcome; Electromyography

MeSH Terms

Asian Continental Ancestry Group
Blood Glucose
Diabetes Mellitus*
Electromyography
Fasting
Hemoglobin A, Glycosylated
Humans
Longitudinal Ligaments
Lower Extremity
Neck
Prospective Studies*
Spinal Cord
Spinal Cord Compression
Spinal Cord Diseases*
Tibial Nerve
Treatment Outcome
Urinary Bladder
Blood Glucose