The Influence of Diabetes on Surgical Outcomes in Cervical Myelopathy.

STUDY DESIGN

A retrospective cohort.

OBJECTIVE

The objective of the study was to determine what effect, if any, diabetes has on surgical outcomes in patients with cervical spondylotic myelopathy (CSM).

SUMMARY OF BACKGROUND DATA

Diabetes is known to impair healing and has been shown to affect outcomes in lumbar surgery, but few studies have assessed outcomes in cervical surgery, and cervical myelopathy in particular.

METHODS

The records of 113 patients operated on by one surgeon were reviewed. Inclusion criteria were a diagnosis of CSM with a Nurick score, surgical interventions, and minimum 2 years follow-up. Patients were divided into two groups according to diabetes status (33 diabetic patients vs. 80 controls) and diabetic patients were further categorized by degree of perioperative glucose control. Simple and multiple regression analyses were done to compare outcomes as recorded by the Nurick score, controlling for age, gender, duration of symptoms, alcohol use, cocaine use, surgical approach, prior surgery, and signal change on preoperative magnetic resonance imaging.

RESULTS

There was no relationship between diabetes status and preoperative Nurick score. However, diabetes status was associated with impaired improvement in Nurick score. Average perioperative glucose in diabetic individuals was linearly associated with impaired improvement in Nurick score.

CONCLUSION

We conclude that hyperglycemia may impair postoperative healing of the spinal cord in patients with CSM.

LEVEL OF EVIDENCE