Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study
Tanishima Shinji, Mihara Tokumitsu, Tanida Atsushi, Takeda Chikako, Murata Masaaki, Takahashi Toshiaki, Yamane Koji, Morishita Tsugutake, Morio Yasuo, Ishii Hiroyuki, Fukata Satoru, Nanjo Yoshiro, Hamamoto Yuki, Dokai Toshiyuki, Nagashima Hideki,
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( Tanishima Shinji )
Tottori University Faculty of Medicine Department of Orthopedic Surgery
( Mihara Tokumitsu )
Tottori University Faculty of Medicine Department of Orthopedic Surgery
( Tanida Atsushi )
Tottori University Faculty of Medicine Department of Orthopedic Surgery
( Takeda Chikako )
Tottori University Faculty of Medicine Department of Orthopedic Surgery
( Murata Masaaki )
Tottori Central Prefectural Hospital Department of Orthopaedic Surgery
( Takahashi Toshiaki )
Tottori Red Cross Hospital Department of Orthopedic Surgery
( Yamane Koji )
Tottori Red Cross Hospital Department of Orthopedic Surgery
( Morishita Tsugutake )
Tottori Municipal Hospital Department of Orthopedic Surgery
( Morio Yasuo )
Misasa Onsen Hospital Department of Orthopaedic Surgery
( Ishii Hiroyuki )
Misasa Onsen Hospital Department of Orthopaedic Surgery
( Fukata Satoru )
Misasa Onsen Hospital Department of Orthopaedic Surgery
( Nanjo Yoshiro )
Sanin Rosai Hospital Department of Orthopedic Surgery
( Hamamoto Yuki )
Matsue City Hospital Department of Orthopaedic Surgery
( Dokai Toshiyuki )
Masuda Redcross Hospital Department of Orthopedic Surgery
( Nagashima Hideki )
Tottori University Faculty of Medicine Department of Orthopedic Surgery
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.
키워드
Neck; Spinal cord compression; Diabetes mellitus; Treatment outcome; Electromyography
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