title: Characteristics of diabetes associated with poor improvements in clinical outcomes after lumbar spine surgery.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  Evaluation of the impact of diabetes on lumbar spine surgery.
  
  
  BACKGROUND
  Characteristics of diabetes that increase the risk of postoperative complications and poor surgical outcomes after lumbar spine surgery remain unclear.
  
  
  METHODS
  The demographic and clinical data of diabetic and nondiabetic patients, 50 years or older, undergoing lumbar spine surgery were reviewed. Japanese Orthopaedic Association and visual analogue scale scores for low back pain, leg pain, and numbness were assessed as perioperative outcomes. Analysis of covariance was used for comparison of perioperative outcomes to adjust for differences between the groups, and a proportional odds model was used to compute the odds ratio of poor improvement in each outcome.
  
  
  RESULTS
  Forty-one patients with diabetes were compared with 124 patients without diabetes. Visual analogue scale scores of final low back pain was higher for patients with than without diabetes (29.3 vs. 17.9, P = 0.013). Complications were similar in patients with and without diabetes except for nonunion after fusion surgery (20% vs. 3%, P = 0.095). When stratified by surgical procedure, final low back pain was significantly higher for patients with diabetes who underwent fusion surgery (39.1 vs. 17.4, P = 0.001). Patients with glycosylated hemoglobin of 6.5% or more displayed a 2-fold increase only in the odds ratio (OR) of poor improvement of low back pain (OR = 2.37; 95% confidence interval [CI], 0.99-5.70). Patients having diabetes for 20 years or more were more likely to experience poor improvement of low back pain and leg numbness (OR = 4.95; 95% CI, 1.69-14.5 and OR = 2.80; 95% CI, 0.98-7.94, respectively). Insulin use was associated with an increased OR for poor improvement of leg numbness (OR = 4.49; 95% CI, 1.24-16.3).
  
  
  CONCLUSIONS
  Longstanding diabetes, poor glycemic control, and insulin use might be associated with poor postoperative improvement.
authors.affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545–8585, Japan. m1112341@med.osaka-cu.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Takahashi
authors.forename: Akinobu
authors.initials: A
authors.lastname: Suzuki
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Toyoda
authors.forename: Hidetomi
authors.initials: H
authors.lastname: Terai
authors.forename: Sho
authors.initials: S
authors.lastname: Dohzono
authors.forename: Kentarou
authors.initials: K
authors.lastname: Yamada
authors.forename: Tomiya
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yasuda
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Tsukiyama
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Shinohara
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin