Nori Satoshi, Nagoshi Narihito, Yoshioka Kenji, Nojiri Kenya, Takahashi Yuichiro, Fukuda Kentaro, Ikegami Takeshi, Yoshida Hideaki, Iga Takahito, Tsuji Osahiko, Suzuki Satoshi, Okada Eijiro, Yagi Mitsuru, Nakamura Masaya, Matsumoto Morio, Watanabe Kota, Ishii Ken, Yamane Junichi
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Keio Spine Research Group (KSRG), Japan.
Spine (Phila Pa 1976). 2021 Apr 1;46(7):433-439. doi: 10.1097/BRS.0000000000003817.
Retrospective multicenter study.
The aim of this study was to identify the impact of diabetes on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM).
Although some previous studies have reported surgical outcomes of posterior decompression for CSM in diabetic patients, their results were inconsistent.
We included 675 patients with CSM who underwent posterior decompression. Patients were divided into diabetic (n = 140) and nondiabetic (n = 535) groups according to the diabetic criteria for glucose intolerance. Surgical outcomes as assessed by the Japanese Orthopedic Association (JOA) scores and visual analog scale (VAS) for neck pain were compared between groups. Subsequently, the functional outcomes of diabetic patients were compared between the mild (n = 131) and moderately severe (n = 9) groups. All patients were followed up for at least 1 year after surgery.
Compared with the nondiabetic group, the diabetic group showed lower pre- and postoperative JOA scores (P = 0.025 and P = 0.001, respectively) and a lower JOA score recovery rate (RR) (P = 0.009). However, the preoperative-to-postoperative changes in JOA scores in the diabetic and nondiabetic groups were not significantly different (P = 0.988). Pre- and postoperative VAS for neck pain and postoperative reduction of neck pain were comparable between groups (P = 0.976, P = 0.913 and P = 0.688, respectively). Although statistical analysis was not performed due to the small underpowered sample size, functional outcomes assessed by the JOA score RR (43.3 ± 37.1% vs. 45.3 ± 33.9%) and preoperative-to-postoperative changes in JOA scores (3.0 ± 2.2 vs. 2.7 ± 2.5) were similar between the mild and moderately severe diabetes groups.
CSM patients with diabetes experienced improvements in neurological function and neck pain as a result of posterior decompression to the same extent seen in patients without diabetes.Level of Evidence: 3.
回顾性多中心研究。
本研究旨在确定糖尿病对脊髓型颈椎病（CSM）后路减压手术疗效的影响。
尽管此前一些研究报告了糖尿病患者CSM后路减压的手术疗效，但其结果并不一致。
我们纳入了675例行后路减压的CSM患者。根据葡萄糖不耐受的糖尿病标准，将患者分为糖尿病组（n = 140）和非糖尿病组（n = 535）。比较两组间采用日本骨科协会（JOA）评分和颈部疼痛视觉模拟量表（VAS）评估的手术疗效。随后，比较轻度糖尿病组（n = 131）和中度重度糖尿病组（n = 9）患者的功能结局。所有患者术后至少随访1年。
与非糖尿病组相比，糖尿病组术前和术后的JOA评分较低（分别为P = 0.025和P = 0.001），JOA评分恢复率（RR）较低（P = 0.009）。然而，糖尿病组和非糖尿病组JOA评分的术前至术后变化无显著差异（P = 0.988）。两组间颈部疼痛VAS评分的术前和术后情况以及术后颈部疼痛减轻程度相当（分别为P = 0.976、P = 0.913和P = 0.688）。尽管由于样本量小且检验效能不足未进行统计学分析，但轻度和中度重度糖尿病组间采用JOA评分RR评估的功能结局（43.3±37.1%对45.3±33.9%）以及JOA评分的术前至术后变化（3.0±2.2对2.7±2.5）相似。
CSM糖尿病患者后路减压后神经功能和颈部疼痛得到改善，程度与非糖尿病患者相同。证据级别：3级。
