The effect of insulin dependent diabetes on bone metabolism and growth after spinal fusion

NaPier, Zachary; Kanim, Linda E.A.; Nelson, Trevor; Salehi, Khosrowdad; Arabi, Yasaman; Glaeser, Juliane D.; Sheyn, Dmitriy; Metzger, Melodie F.

doi:10.1016/j.spinee.2019.11.011

Cited by 13 publications

(13 citation statements)

References 33 publications

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“…Among the patients undergoing surgery for pseudarthrosis, 82% had a metabolic or endocrine disease. In an experimental animal model study, rats with insulin-dependent DM demonstrated significantly lower fusion rates than did healthy rats undergoing spinal fusion (16.7% vs. 43%, P < 0.05) 20 . In a retrospective analysis of anterior lumbar interbody fusion, the rate of fusion failure among smokers was significantly higher than that among nonsmokers (OR 37.10, P = 0.002) 24 .…”

Section: Discussionmentioning

confidence: 93%

“…In an experimental animal model study, rats with insulin-dependent DM demonstrated significantly lower fusion rates than did healthy rats undergoing spinal fusion (16.7% vs. 43%, P < 0.05). 20 In a retrospective analysis of anterior lumbar interbody fusion, the rate of fusion failure among smokers was significantly higher than that among nonsmokers (OR 37.10, P ¼ 0.002). 24 The present study also showed that pseudarthrosis was less likely to resolve spontaneously over time in patients with DM and smoking (adjusted OR: 2.817, P ¼ 0.007 and adjusted OR: 6.497, P ¼ 0.008, respectively).…”

Section: Discussionmentioning

confidence: 96%

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Prognosis of Symptomatic Pseudarthrosis Observed at 1 Year After Lateral Lumbar Interbody Fusion

Jung

Chung

Kim

et al. 2021

Spine

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Study Design. Retrospective cohort study.Objective. The aim of this study was to investigate the prognosis of symptomatic pseudarthrosis observed at 1 year after lateral lumbar interbody fusion (LLIF) surgery and to analyze the risk factors for persistent pseudarthrosis for 2 years postoperatively. Summary of Background Data. Few articles have evaluated the prognosis of symptomatic pseudarthrosis following LLIF surgery. Methods. One hundred fifty-two patients with a minimum follow-up of 2 years were screened. Fusion status was assessed at 1 year postoperatively, and unfused segments were reevaluated at 2 years postoperatively. Dynamic x-rays and computed tomography images were acquired to evaluate the fusion status. Demographic data were evaluated to identify the risk factors associated with persistent pseudarthrosis. Clinical outcomes, including the visual analog scale (VAS) for back/leg pain and the Oswestry disability index (ODI), were evaluated preoperatively and at 1 and 2 years postoperatively. Results. Symptomatic pseudarthrosis was detected in 42 patients at 1 year postoperatively. Among them, 23 patients (54.8%) exhibited solid bony fusion 2 years postoperatively without further intervention. Fourteen patients (33.3%) showed asymptomatic pseudarthrosis, and the remaining five patients (11.9%) showed symptomatic pseudarthrosis. Multivariable analysis showed that diabetes (adjusted odds ratio [OR]: 2.817, P ¼ 0.007), smoking (adjusted OR: 6.497, P ¼ 0.008), and fusion at more than three levels (adjusted OR: 2.525, P ¼ 0.031) were risk factors for persistent pseudarthrosis. Improvements in the VAS scores for back pain and ODI scores were significantly lower in the persistent pseudarthrosis group than in the final solid fusion group at 2 years postoperatively. Conclusion. It is not necessary to intervene for all patients in whom symptomatic pseudarthrosis is detected at 1 year postoperatively because only 11.9% of them will show persistent symptomatic pseudarthrosis. However, early revision surgery should be considered when severe symptomatic pseudarthrosis associated with diabetes, smoking, and fusion at more than three levels is present.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Prognosis of Symptomatic Pseudarthrosis Observed at 1 Year After Lateral Lumbar Interbody Fusion

Jung

Chung

Kim

et al. 2021

Spine

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“…They detected significant reduction in bone mineral density, bone volume, structural mechanical index, and trabecular thickness. A significant increase in IL-1β, IL-5, IL-10, TNF-α and KC/GRO (CXCL1) levels were detected locally in the fusion beds of IDDM, also in blood samples of animal models which showed that the elevated cytokine levels may be rather a result of systemic cytokine dysregulation than a local response only [11] . In our case, patient had a history of diabetes in the past 10 years with insulin treatment that contributed as a risk factor in developing a non-union lumbar fusion.…”

Section: Discussionmentioning

confidence: 96%

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

Mahadhipta

Ajiantoro

Tendean

et al. 2022

International Journal of Surgery Case Reports

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“…Сахарный диабет. Большое влияние в патогенезе развития рецидивов грыж диска современные авторы отводят сахарному диабету обоих типов, отмечая значительный рост рецидивов грыж диска среди пациентов с данными заболеваниями [28,[40][41][42][43]. Общепризнано, что пациенты с сахарным диабетом имеют худшие результаты после первичной операции на межпозвонковом диске поясничного отдела позвоночника, в сравнении с пациентами без сахарного диабета.…”

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“…Mobbs et al [44] сообщили, что в их исследовании в группе пациентов с сахарным диабетом, оперированных по поводу грыжи межпозвонкового диска на поясничном уровне, в 28 % случаев был отмечен рецидив грыжи, в то время как в контрольной группе пациентов без диабета рецидив был отмечен в 3,5 % случаев. NaPier et al [40] провели исследования на лабораторных крысах, каждая из которых подвергалась заднебоковому спондилодезу с использованием аутотрансплантата копчика, при этом 22 из 42 крыс получали имплантируемую таблетку инсулина. По сравнению со здоровыми крысами, подвергшимися спондилодезу, крысы с инсулинозависимым диабетом продемонстрировали значительное снижение скорости формирования костного блока (16,7 % крыс против 43,0 %).…”

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Pathogenetic aspects and risk factors for recurrent lumbar disc herniation: literature review

et al. 2021

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One of the main causes of the development of debilitating pain syndrome after surgical treatment of a herniated disc is herniation recurrence. This pathology dictates the need to perform reoperation on an already operated segment of the spinal column, which complicates the technique of surgical intervention and negatively affects the relief of pain syndrome. In the presented review of scientific publications selected from the medical literature databases PubMed, E-library and Cochrane, the current problems of the pathogenesis of recurrent herniated discs in the lumbar spine are considered. The concept of risk factors for the development of recurrent disc herniation is highlighted, their characteristics are given, and the significance of each of them in the development of recurrent disc herniation is analyzed.

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The effect of insulin dependent diabetes on bone metabolism and growth after spinal fusion

Cited by 13 publications

References 33 publications

Prognosis of Symptomatic Pseudarthrosis Observed at 1 Year After Lateral Lumbar Interbody Fusion

Prognosis of Symptomatic Pseudarthrosis Observed at 1 Year After Lateral Lumbar Interbody Fusion

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

Pathogenetic aspects and risk factors for recurrent lumbar disc herniation: literature review

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