Mild Diabetes Is Not a Contraindication for Surgical Decompression in Cervical Spondylotic Myelopathy: Results of the AOSpine North America Multicenter Prospective Study (CSM)

Details

• Personal Author:
  Arnold PM ; Banco RJ ; Bono CM ; Brodke DS ; Chapman JR ; Dekutoski MB ; Fehlings MG ; Gokaslan ZL ; Janssen ME ; Kopjar B ; Massicotte EM ; Sasso RC ; Shaffrey CI ; Smith JS ; Vaccaro AR ; Woodard EJ ; Yoon ST
• Description:
  Background context: Cervical spondylotic myelopathy (CSM) is a chronic spinal cord disease and can lead to progressive or stepwise neurologic decline. Several factors may influence this process, including extent of spinal cord compression, duration of symptoms, and medical comorbidities. Diabetes is a systemic disease that can impact multiple organ systems, including the central and peripheral nervous systems. There has been little information regarding the effect of diabetes on patients with coexistent CSM. Purpose: To provide empirical data regarding the effect of diabetes on treatment outcomes in patients who underwent surgical decompression for coexistent CSM. Study design/setting: Large prospective multicenter cohort study of patients with and without diabetes who underwent decompressive surgery for CSM. Patient sample: Two hundred thirty-six patients without and 42 patients with diabetes were enrolled. Of these, 37 were mild cases and five were moderate cases. Four required insulin. There were no severe cases associated with end-organ damage. Outcome measures: Self-report measures include Neck Disability Index and version 2 of 36-Item Short Form Health Survey (SF-36v2), and functional measures include modified Japanese Orthopedic Association (mJOA) score and Nurick grade. Methods: We compared presurgery symptoms and treatment outcomes between patients with and without diabetes using univariate and multivariate models, adjusting for demographics and comorbidities. Results: Diabetic patients were older, less likely to smoke, and more likely to be on social security disability insurance. Patients with diabetes presented with a worse Nurick grade, but there were no differences in mJOA and SF-36v2 at presentation. Overall, there was a significant improvement in all outcome parameters at 12 and 24 months. There was no difference in the level of improvement between the patients with and without diabetes, except in the SF-36v2 Physical Functioning, in which diabetic patients experienced significantly less improvement. There were no differences in surgical complication rates between diabetic patients and nondiabetic patients. Conclusions: Except for a worse Nurick grade, diabetes does not seem to affect severity of symptoms at presentation for surgery. More importantly, with the exception of the SF-36v2 Physical Functioning scores, outcomes of surgical treatment are similar in patients with diabetes and without diabetes. Surgical decompression is effective and should be offered to patients with diabetes who have symptomatic CSM and are appropriate surgical candidates. [Description provided by NIOSH]
• Subjects:
  Blood Cohort Studies Hematologic Diseases Nervous System Nervous System Diseases Occupational Health Safety
• Keywords:
  Author Keywords: Cervical Spondylotic Myelopathy Blood Sugar Disorders Cohort Studies Diabetes Functional Outcomes Neurological Disorders Quality Of Life Spinal Cord Disorders Surgery Surgical Treatment
• ISSN:
  1529-9430
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Arizona ; Colorado ; Georgia ; Indiana ; Kansas ; Maryland ; Massachusetts ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 7 ; OSHA Region 8 ; OSHA Region 9 ; Pennsylvania ; Utah ; Virginia ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  65-72
• Volume:
  14
• Issue:
  1
• NIOSHTIC Number:
  nn:20055415
• Citation:
  Spine J 2014 Jan; 14(1):65-72
• Contact Point Address:
  Paul M. Arnold MD, Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS 66160, USA
• Email:
  parnold@kumc.edu
• Federal Fiscal Year:
  2014
• Performing Organization:
  University of Washington
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  The Spine Journal
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6248a6b4c1b402e1860f2c96b4eb367074d6633d324fb87d5544dfb2b6f6181d65a9ace6237fb5cce5387c07254a9f960bf40317ac7062995f8e39c97ec7ae5f
• Download URL:
  https://stacks.cdc.gov/view/cdc/213274/cdc_213274_DS1.pdf
• File Type:
  [PDF - 311.16 KB ]