Hyperglycemia and its influence on development of lumbar degenerative disc disease

Abstract

Study Design A Retrospective observational study. Objectives To determine the influence of hyperglycemia on severity of lumbar degenerative disc disease (LDDD). Methods We retrospectively included 199 patients with low back pain (LBP) who visited our tertiary care hospital from June 2016 to December 2018. All patients divided into three groups as per inclusion and exclusion criteria. Group-A had patients without DM ( n = 75). Group B had well-controlled DM patients ( n = 72) and Group-C had uncontrolled DM patients ( n = 52). Group B and C subdivided according to dutation of DM. Group-B1 DM duration was ≤ 10 years ( n = 38), Group-B2 DM duration was >10 years ( n = 34), Group-C1 DM duration ≤10 years ( n = 28), Group-C2 DM duration >10 years ( n = 24). Sex, age, BMI, occupation, smoking history, alcohol use and duration of type-II DM were recorded. The severity of LDDD was evaluated using the five-level Pfirrmann grading system. Operated patient's disc material sent for histological examination. Results Patients with DM showed more severe disc degeneration compared to 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). Group-B2 and Group-C2 showed higher average Pfirrmann-scores than Group-B1 and Group-C1 ( p > 0.05). Group-C1 and Group-C2 showed higher average Pfirrmann-scores than Group-B1 and B2 ( p > 0.05). The severity of LDDD was significantly related to DM duration both in groups B & C ( p > 0.05). DM groups showed increased disc apoptosis and matrix aggrecan fragmentation, Disc glycosaminoglycan content and histological significantly different, the results are similar to Pfirrmann-score results. Conclusions There is a positive relationship between diabetes and LDDD. A longer the duration and poor control of hyperglycemia could aggravate disc degeneration.

Platelet-Derived Biomaterials Exert Chondroprotective and Chondroregenerative Effects on Diabetes Mellitus-Induced Intervertebral Disc Degeneration

“…A retrospective study also concluded that prolonged T2DM and its bad control could result in severe disc degeneration [5]. Kakadiya et al also found that DM patients exhibited worse IVD degeneration than non-DM patients, showing increased disc apoptosis and matrix aggrecan fragmentation [32]. Interestingly, a statistically lower IVD height between the 2nd and 3rd lumbar vertebrae has been reported in diabetic patients [33].…”

Modulation of the biological network of lumbar spinal stenosis by Tongdu Huoxue Decoction based on clinical metabolomics

“…By quantifying circulating levels of specific bile acids, Taurohyodeoxycholic acid was found to be negatively associated with diabetes( Choucair et al, 2020 ). The association between diabetes and LSS is a risk factor for developing LSS, and prolonged and poorly controlled hyperglycaemia can exacerbate disc degeneration( Asadian et al, 2016 ; Kakadiya et al, 2020 ). Upregulation of Chenodeoxycholic acid 3-sulfate levels is thought to disrupt the metabolic processes of the body’s antioxidant defence ( Wang et al, 2021 ).…”

Time Trends and Sex Differences in the Association between Diabetes and Chronic Neck Pain, Chronic Low Back Pain, and Migraine. Analysis of Population-Based National Surveys in Spain (2014–2020)

“…Among the possible causes that can explain the association of spinal pain (NP and/or LBP) with diabetes are that people with diabetes have an increased risk of cartilage inflammation, loss of muscle strength, spinal stenosis, and degenerative intervertebral disc (IVD) disease [ 6 , 7 , 8 , 13 , 14 ]. The arguments for a spurious association between spinal pain and diabetes include the confounding effect of obesity, depression, and sedentarism, conditions more frequent among people with diabetes than without [ 6 , 7 , 8 ].…”