Diabetes Mellitus—A Risk Factor for the Development of Lumbar Disc Degeneration: A Retrospective Study of an Indian Population

Abstract

Study Design: A retrospective study. Objectives: To determine the association between type-2 diabetes mellitus (T2DM) and the severity of lumbar disc degeneration disease (LDDD). Methods: We included 199 patients with low back pain (LBP) who visited our hospital from 2016 to 2018. All patients were divided into 3 groups as per inclusion criteria. Group A, patients without DM (n = 75); group B, patients with controlled DM (n = 72); and group C, patients with uncontrolled DM (n = 52). The patients were further subdivided into group B1, DM duration ≤10 years (n = 38); group B2, DM duration >10 years (n = 34); group C1 DM duration ≤10 years (n = 28); and group C2, DM duration >10 years (n = 24). Sex, age, body mass index, occupation, smoking history, alcohol use, and duration of T2DM were recorded. The severity of LDDD was evaluated using the 5-level Pfirrmann grading system. Operated patients’ disc materials were sent for histological examination. Results: Demographic data showed no difference among groups ( P > 0.5), except age. Patients with DM showed more severe disc degeneration compared with patients without DM. The average Pfirrmann scores between groups A and B1 had no difference; groups B2, C1, and C2 showed higher average Pfirrmann scores than group A ( P < 0.05). Groups B2 and C2 showed higher average Pfirrmann scores than groups B1 and C1 ( P < 0.05). Groups C1 and C2 showed higher average Pfirrmann scores than groups B1 and B2 ( P < 0.05). The severity of LDDD was significantly related to DM duration in both groups B and C ( P < 0.05). DM groups showed increased disc apoptosis and matrix aggrecan fragmentation, disc glycosaminoglycan content and histological analysis were significantly different; the results are similar to Pfirrmann score results. Conclusions: DM duration >10 years and uncontrolled DM were risk factors for LDDD.

Diabetes increases risk of lumbar spinal fusion complications: association with altered structure of newly formed bone at the fusion site

“…In line with other studies, 6 , 10 , 11 we found intervertebral disc degeneration and degenerative spondylolisthesis as being disproportionally more frequent indications for primary spinal fusion surgery in patients with diabetes than was expected from the prevalence of this disease in the studied population. In this study, we showed that spine degenerative conditions are major contributors to the development of ASD in diabetic individuals requiring revision surgery (RR = 2.26; 95% CI, 1.45–3.53).…”

Association between spinal and non-spinal health conditions reported in epidemiological studies: a scoping review protocol

“…7 SPPs and NSHCs are concurrently listed in the global top 20 leading causes of years lived with disability, inflicting enormous health and financial tolls on individuals and society. 2 3 Associations have been reported between SPPs and NSHCs, including mental health disorders, [8][9][10][11] diabetes, [11][12][13][14] obesity 15 and various musculoskeletal conditions. 16 17 Such associations are important to consider because they may complicate the clinical management of patients and they are related to lower quality of life, poorer functional status and increased utilisation of healthcare.…”

AMPK as a Potential Therapeutic Target for Intervertebral Disc Degeneration

“…The etiology of IDD is multifactorial and not completely elucidated. To date, multiple factors have been recognized involved in the progression of IDD, such as ageing, smoking, diabetes mellitus (DM), obesity, abnormal mechanical load and genetic predisposition ( Figure 1 ) ( Kim et al, 2009 ; Le Maitre et al, 2007 ; Jeong et al, 2014 ; Desmoulin et al, 2020 ; Maclean et al, 2004 ; Walsh and Lotz, 2004 ; Wuertz et al, 2009 ; Kalb et al, 2012 ; Martirosyan et al, 2016 ; Alpantaki et al, 2019 ; Kakadiya et al, 2020 ; Livshits et al, 2001 ; Chen et al, 2018 ; Cannata et al, 2020 ). In response to those risk factors, various crucial pathological processes develop, including the loss of resident IVD cells, ECM remodeling, inflammation and oxidative stress ( Figure 1 ) ( Gruber and Hanley, 1998 ; Nasto et al, 2013 ; Suzuki et al, 2015 ; Lyu et al, 2021 ).…”