Department of Spine Surgery, Orthopedics Center of Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, People's Republic of China.
Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China.
Eur Spine J. 2023 Jun;32(6):2101-2109. doi: 10.1007/s00586-023-07605-8. Epub 2023 Apr 30.
To assess the impact of diabetes mellitus (DM) on the postoperative motor and somatosensory functional recoveries of degenerative cervical myelopathy (DCM) patients.
Motor and somatosensory evoked potentials (MEP and SSEPs) and modified Japanese Orthopedic Association (mJOA) scores were recorded in 27 diabetic (DCM-DM group) and 38 non-diabetic DCM patients (DCM group) before and 1 year after surgery. The central motor (CMCT) and somatosensory (CSCT) conduction time were recorded to evaluate the conductive functions of the spinal cord.
The mJOA scores, CMCT and CSCT improved (t test, p < 0.05) in both of the DCM-DM and DCM groups 1 year after surgery. The mJOA recovery rate (RR) and CSCT recovery ratio were significantly worse (t test, p < 0.05) in the DCM-DM group compared to the DCM group. DM proved to be a significant independent risk factor for poor CSCT recovery (OR = 4.52, 95% CI 2.32-7.12) after adjusting for possible confounding factors. In DCM-DM group, CSCT recovery ratio was also correlated with preoperative HbA1 level (R = - 0.55, p = 0.003). Furthermore, DM duration longer than 10 years and insulin dependence were risk factors for lower mJOA, CMCT and CSCT recoveries among all DCM-DM patients (t test, p < 0.05).
DM may directly hinders spinal cord conduction recovery in DCM patients after surgery. Corticospinal tract impairments are similar between DCM and DCM-DM patients, but significantly worsened in chronic or insulin-dependent DM patients. The dorsal column is more sensitively affected in all DCM-DM patients. Deeper investigation into the mechanisms and neural regeneration strategies is needed.
评估糖尿病（DM）对退行性颈椎脊髓病（DCM）患者术后运动和感觉功能恢复的影响。
对 27 例糖尿病（DCM-DM 组）和 38 例非糖尿病 DCM 患者（DCM 组）术前及术后 1 年的运动和体感诱发电位（MEP 和 SSEP）和改良日本矫形协会（mJOA）评分进行记录。记录中枢运动（CMCT）和体感（CSCT）传导时间，以评估脊髓的传导功能。
术后 1 年，DCM-DM 组和 DCM 组 mJOA 评分、CMCT 和 CSCT 均有改善（t 检验，p<0.05）。与 DCM 组相比，DCM-DM 组 mJOA 恢复率（RR）和 CSCT 恢复比值明显更差（t 检验，p<0.05）。DM 是 CSCT 恢复不良的独立危险因素（OR=4.52，95%CI 2.32-7.12），调整可能的混杂因素后仍有统计学意义。在 DCM-DM 组中，CSCT 恢复比值与术前 HbA1 水平呈负相关（R=-0.55，p=0.003）。此外，DM 病程>10 年和胰岛素依赖是所有 DCM-DM 患者 mJOA、CMCT 和 CSCT 恢复不良的危险因素（t 检验，p<0.05）。
DM 可能直接影响 DCM 患者术后脊髓传导的恢复。DCM 患者与 DCM-DM 患者的皮质脊髓束损伤相似，但在慢性或胰岛素依赖型 DM 患者中更为严重。所有 DCM-DM 患者的后索均受到更明显的影响。需要进一步深入研究其机制和神经再生策略。
