title: Mild diabetes is not a contraindication for surgical decompression in cervical spondylotic myelopathy: results of the AOSpine North America multicenter prospective study (CSM).
abstract: BACKGROUND
  Cervical spondylotic myelopathy (CSM) is a chronic spinal cord disease and can lead to progressive or stepwise neurologic decline. Several factors may influence this process, including extent of spinal cord compression, duration of symptoms, and medical comorbidities. Diabetes is a systemic disease that can impact multiple organ systems, including the central and peripheral nervous systems. There has been little information regarding the effect of diabetes on patients with coexistent CSM.
  
  
  OBJECTIVE
  To provide empirical data regarding the effect of diabetes on treatment outcomes in patients who underwent surgical decompression for coexistent CSM.
  
  
  METHODS
  Large prospective multicenter cohort study of patients with and without diabetes who underwent decompressive surgery for CSM.
  
  
  METHODS
  Two hundred thirty-six patients without and 42 patients with diabetes were enrolled. Of these, 37 were mild cases and five were moderate cases. Four required insulin. There were no severe cases associated with end-organ damage.
  
  
  METHODS
  Self-report measures include Neck Disability Index and version 2 of 36-Item Short Form Health Survey (SF-36v2), and functional measures include modified Japanese Orthopedic Association (mJOA) score and Nurick grade.
  
  
  METHODS
  We compared presurgery symptoms and treatment outcomes between patients with and without diabetes using univariate and multivariate models, adjusting for demographics and comorbidities.
  
  
  RESULTS
  Diabetic patients were older, less likely to smoke, and more likely to be on social security disability insurance. Patients with diabetes presented with a worse Nurick grade, but there were no differences in mJOA and SF-36v2 at presentation. Overall, there was a significant improvement in all outcome parameters at 12 and 24 months. There was no difference in the level of improvement between the patients with and without diabetes, except in the SF-36v2 Physical Functioning, in which diabetic patients experienced significantly less improvement. There were no differences in surgical complication rates between diabetic patients and nondiabetic patients.
  
  
  CONCLUSIONS
  Except for a worse Nurick grade, diabetes does not seem to affect severity of symptoms at presentation for surgery. More importantly, with the exception of the SF-36v2 Physical Functioning scores, outcomes of surgical treatment are similar in patients with diabetes and without diabetes. Surgical decompression is effective and should be offered to patients with diabetes who have symptomatic CSM and are appropriate surgical candidates.
authors: Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS 66160, USA. Electronic address: parnold@kumc.edu.
authors: Paul M
authors: PM
authors: Arnold
authors: Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, 399 Bathurst St, #4W-449, Toronto, ON, Canada.
authors: Michael G
authors: MG
authors: Fehlings
authors: Department of Health Services, University of Washington, Box 359455, 4333 Brooklyn Ave NE, Rm 14-315, Seattle, WA 98195-9455, USA.
authors: Branko
authors: B
authors: Kopjar
authors: Department of Orthopaedic Surgery, Emory University, Emory Orthopaedics & Spine Center, 59 Executive Park South, Atlanta, GA 30329, USA.
authors: Sangwook Tim
authors: ST
authors: Yoon
authors: Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, 399 Bathurst St, #4W-449, Toronto, ON, Canada.
authors: Eric M
authors: EM
authors: Massicotte
authors: Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107-4216, USA.
authors: Alexander R
authors: AR
authors: Vaccaro
authors: Department of Orthopaedics, University of Utah, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors: Darrel S
authors: DS
authors: Brodke
authors: Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908-0212, USA.
authors: Christopher I
authors: CI
authors: Shaffrey
authors: Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908-0212, USA.
authors: Justin S
authors: JS
authors: Smith
authors: Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA.
authors: Eric J
authors: EJ
authors: Woodard
authors: Boston Spine Group, 299 Washington St, Newton, MA 02458, USA.
authors: Robert J
authors: RJ
authors: Banco
authors: Department of Orthopaedics, University of Washington, Orthopaedic Trauma Surgery Clinic at Harborview, Harborview Medical Center, 1 West Clinic, Box 359798, 325 Ninth Ave, Seattle, WA 98104, USA.
authors: Jens R
authors: JR
authors: Chapman
authors: Spine Education and Research Institute, Center for Spinal Disorders, 9005 Grant St., Suite 200, Thornton, CO 80229, USA.
authors: Michael E
authors: ME
authors: Janssen
authors: Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
authors: Christopher M
authors: CM
authors: Bono
authors: Department of Orthopedic Surgery, Indiana Spine Group, 8040 Clearvista Parkway, Suite 450, Indianapolis, IN 46256, USA.
authors: Rick C
authors: RC
authors: Sasso
authors: The CORE Institute, Center for Orthopedic Research and Education, 3010 W. Agua Fria Fwy #100, Phoenix, AZ 85027, USA.
authors: Mark B
authors: MB
authors: Dekutoski
authors: Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 7-109, 600 North Wolfe St., Baltimore, MD 21287, USA.
authors: Ziya L
authors: ZL
authors: Gokaslan
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D000075202:Contraindications; D019299:Decompression, Surgical / Q000379:methods; D003920:Diabetes Mellitus / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013117:Spinal Cord Compression / Q000150:complications / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cervical spondylotic myelopathy; Diabetes; Functional outcomes; Quality of life; Surgical treatment