Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion?

Abstract

Study Design: Retrospective cohort study. Objective: To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing posterior lumbar spinal fusion. Methods: Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected. Results: A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger ( P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery ( P = .018). No differences were observed in reoperation or postoperative complication. Conclusions: While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.

The Effects of Underlying Comorbidities on Surgical Outcome in Patients With Spondylolisthesis Undergoing Surgical Treatment

“…Khan et al in contrast to our study observed no difference between the diabetic and nondiabetic groups in terms of clinical outcomes. Similarly, no difference was observed between the two groups in terms of the need for reoperation or postoperative complications [10] and a history of diabetes had no effect on exacerbation of poor prognosis. Oster et al reported that a history of diabetes or smoking did not affect the prognosis of surgery in these patients [11].…”

A systematic review and meta-analysis of risk factors for reoperation after degenerative lumbar spondylolisthesis surgery

“…However, results of studies on the risk factors for reoperation of DLS patients remain controversial. Rabah et al, have reported that diabetes was related to greater risk of reoperation [ 11 ], while Khan et al reported no significant association between diabetes and reoperation [ 12 ]. In the study performed by Zhong et al, obesity was found to be associated with a higher incidence of unplanned reoperations [ 8 ].…”