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

Effect of type 2 diabetes mellitus on patients undergoing percutaneous endoscopic lumbar discectomy: a retrospective propensity score-matched cohort study

OBJECTIVE

The effect of Type 2 diabetes mellitus (T2DM) on lumbar disc herniation (LDH) remains controversial. This retrospective cohort study aims to investigate the effect of T2DM on the LDH patients underwent percutaneous endoscopic lumbar discectomy (PELD) throughout pre, peri and post operation.

METHODS

This study included patients underwent PELD surgery from October 2021 to January 2024. General data including age, gender and body mass index (BMI), hemoglobin, hypertension and coronary heart disease (CHD) were collected. Clinical data including Visual Analogue Scale (VAS) score, surgical time, blood loss, length of hospital stay, recurrence ratio and reoperation ratio were recorded. Imaging data include L1-5 cobb angle, lumbar range of motion (ROM), relative cross-sectional area (CSA) and fat infiltration ratio (FIR) of the paraspinal muscles, abdominal aorta calcification (AAC), disc Pfirrmann grading, herniated disc Michigan State University (MSU) classification and Lee Zoning et al. were measured. Propensity score-matched (PSM) analysis with 1:1 ratio was performed to eliminate the influence of confounding factors using a multi-variable logistic regression model before analysis.

RESULTS

728 patients were eligible in this study, and significant difference was detected in age, hypertension and CHD between the T2DM group and Control group. After PSM analysis and matching, 56 pairs of patients generated and were included for further analysis. The patients in the T2DM possessed significantly higher grades of Pfirrmann score and AAC ratio (48.21% vs. 25.00%) than control group. Postoperative VAS of the T2DM group was 2(IQR = 1), which was significantly higher than the Control group, which was 1(IQR = 2). The recurrence and reoperation ratio were 21.43% and 16.07% respectively in the T2DM group, both of which were notably higher than the Control group (5.36% and 1.79%).

CONCLUSION

T2DM may aggravate disc degeneration, impede postoperative symptom relief, and increase recurrence and reoperation rates after PELD.

Association of Elevated Perioperative Blood Glucose With Complications and Postoperative Outcomes Following Traumatic Spine Surgery

BACKGROUND

Perioperative blood glucose control has been demonstrated to influence outcomes following spine surgery, though this association has not been fully elucidated in patients with traumatic spine injuries. This study sought to determine the association between perioperative blood glucose levels and complications or outcomes in patients undergoing spine surgery due to injury.

METHODS

A retrospective review was conducted to identify patients who underwent spine surgery due to traumatic injuries between 1 March 2020 and 29 September 2022 at a single academic institution. Descriptive factors, complications, and outcomes were compared between those with a postoperative blood glucose level of <200 mg/dL and those with a preoperative glucose of <200 mg/dL.

RESULTS

Patients with a post- and preoperative blood glucose of ≥200 mg/dL had significantly higher odds of respiratory complications (OR = 2.1, 2.1, P = 0.02, 0.03), skin/wound complications (OR = 2.2, 2.8, P = 0.04, 0.03), and increased hospital length of stay (OR = 9.6, 12.1, P = 0.02, 0.03) compared with those with blood glucose of <200 mg/dL. Those with postoperative glucose ≥200 mg/dL also had significantly higher odds of inpatient mortality (OR = 4.5, P = 0.04) when controlling for confounding factors. Neither pre- nor postoperative blood glucose of ≥200 mg/dL was associated with an improvement in American Spinal Injury Association Impairment Scale score at the final follow-up when controlling for multiple confounding factors (P = 0.44, 0.06).

CONCLUSION

Elevated blood glucose both pre- and postoperatively was associated with an increased rate of postoperative complications and negative postoperative outcomes. However, there was no association between elevated blood glucose levels and neurological recovery following traumatic spinal injury.

LEVEL OF EVIDENCE: 3

The Effects of Blood Glucose Control in the Operative Spine Patient: A Systematic Review

OBJECTIVE

To our knowledge, this is the first systematic review to evaluate the available literature on the effects of perioperative serum glucose (SG) on outcomes for patients undergoing spine surgery. This review will add insight into how the perioperative management of SG affects the outcomes of patients undergoing spine surgery.

METHODS

Three databases were used in this review including Embase, PubMed, and Cochrane Library. The searches were from 2012 to 2022 and included the terms "spine surgery" and "glucose level" to identify studies that demonstrated a correlation between glucose level and postoperative outcomes. Pediatric studies, those that did not specify spine surgical outcomes related to glucose levels, and non-English studies were excluded. The methodological items for nonrandomized studies score was used to assess risk of bias in the included studies.

RESULTS

This review included a total of 9 cohort studies, both prospective and retrospective, encompassing a total of 431,156 subjects. Seven of the 9 studies reported an increased overall complication rate among patients with diabetes or with higher SG levels, and 4 studies demonstrated an increased infection rate among this population. Two studies reported an association between decreased SG levels and improved neurological recovery when a deficit was present preoperatively, and 1 of the studies found that this association was statistically significant.

LIMITATIONS

Limitations of this review include lack of standardization regarding type of surgery, location of the spine, and level of evidence.

CONCLUSION

Most of the current literature suggests that elevated SG levels in patients undergoing spine surgery likely leads to higher complication rates and may lead to increased infection rates, and this review reinforced the current evidence. Additionally, perioperative SG levels may be associated with the extent of neurological recovery after surgery, but further investigation may be warranted.

CLINICAL RELEVANCE

This review adds to the current body of evidence regarding perioperative SG levels and its association with complications.

LEVEL OF EVIDENCE: 2

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

BACKGROUND

Considering the high reoperation rate in degenerative lumbar spondylolisthesis (DLS) patients undergoing lumbar surgeries and controversial results on the risk factors for the reoperation, we performed a systematic review and meta-analysis to explore the reoperation rate and risk factors for the reoperation in DLS patients undergoing lumbar surgeries.

METHODS

Literature search was conducted from inception to October 28, 2022 in Pubmed, Embase, Cochrane Library, and Web of Science. Odds ratio (OR) was used as the effect index for the categorical data, and effect size was expressed as 95% confidence interval (CI). Heterogeneity test was performed for each outcome effect size, and subgroup analysis was performed based on study design, patients, surgery types, follow-up time, and quality of studies to explore the source of heterogeneity. Results of all outcomes were examined by sensitivity analysis. Publication bias was assessed using Begg test, and adjusted using trim-and-fill analysis.

RESULTS

A total of 39 cohort studies (27 retrospective cohort studies and 12 prospective cohort studies) were finally included in this systematic review and meta-analysis. The overall results showed a 10% (95%CI: 8%-12%) of reoperation rate in DLS patients undergoing lumbar surgeries. In surgery types subgroup, the reoperation rate was 11% (95%CI: 9%-13%) for decompression, 10% (95%CI: 7%-12%) for fusion, and 9% (95%CI: 5%-13%) for decompression and fusion. An increased risk of reoperation was found in patients with obesity (OR = 1.91, 95%CI: 1.04-3.51), diabetes (OR = 2.01, 95%CI: 1.43-2.82), and smoking (OR = 1.51, 95%CI: 1.23-1.84).

CONCLUSIONS

We found a 10% of reoperation rate in DLS patients after lumbar surgeries. Obesity, diabetes, and smoking were risk factors for the reoperation.