A Study on the Pattern of Spinal Cord Involvement in Type 2 Diabetes Mellitus Patients with and without Nerve Conduction Study-Proven Neuropathy: A Cross-Sectional Analytical Study.

BACKGROUND

Diabetic myelopathy is the pathological changes in the spinal cord due to diabetes. Despite extensive histopathological evidence supporting spinal cord atrophy, only two in vivo studies have reported radiological spinal cord atrophy, without any electrophysiological correlation, in diabetic patients.

OBJECTIVE

Our study aims to determine the radiological and electrophysiological patterns of spinal cord involvement in patients with and without nerve conduction study-proven neuropathy.

METHODS AND MATERIALS

A cross-sectional analytical study was conducted on all consenting type 2 diabetic patients, 18-65 years old, admitted to our diabetic ward after executing stringent inclusion and exclusion criteria. After screening and categorizing the patients for neuropathy via clinical and electrophysiological methods, the patients were subjected to magnetic resonance imaging of the cervical spine and somatosensory evoked potential to trace radiological and electrophysiological evidence of spinal cord involvement and also to make a comparison between neuropathy and non-neuropathy subjects.

FINDINGS

We demonstrated significant radiological spinal cord atrophy (P value 0.006) and electrophysiological slowing of conduction velocities within the spinal cord (P value <0.001) in patients with diabetic neuropathy as compared to diabetic patients without neuropathy. Furthermore, the post hoc analysis suggested a significant association of the severity of neuropathy with the severity of myelopathy (χ2 11.927, P value 0.003) and glycemic status (χ2 7.564, P value 0.023).

INTERPRETATION

The study demonstrates significant radiological and electrophysiological spinal cord involvement in diabetic neuropathy patients than in non-neuropathy patients. The severity of spinal cord involvement is associated with the severity of neuropathy.