RF90#075]
Rapid Fire
Impact of Diabetes Mellitus on Surgical Outcomes in Degenerative Cervical Myelopathy: a Prospective Multicenter Study
Narihito Nagoshi, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）Junichi Yamane, MD, PhD （Department of Orthopaedic Surgery, Kanagawa Prefectural Police Association Keiyu Hospital, Kanagawa, Japan）Toshiki Okubo, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）Tatsuya Yamamoto, MD, PhD （Department of Orthopaedic Surgery, Japan Red Cross Shizuoka Hospital, Shizuoka, Japan）Takeshi Ikegami, MD, PhD （Department of Orthopaedic Surgery, Fussa Hospital, Tokyo, Japan） Kentaro Ago, MD, PhD （Department of Orthopaedic Surgery, Fussa Hospital, Tokyo, Japan）Kazuya Kitamura, MD, PhD （Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan）Kentaro Fukuda, MD, PhD （Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan）Takeshi Fujii, MD, PhD （Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan）Takahito Iga, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）Kazuki Takeda, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）Satoshi Suzuki, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）Masahiro Ozaki, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan） Morio Matsumoto, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan） Masaya Nakamura, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）Kota Watanabe, MD, PhD （Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan）
Introduction: The influence of diabetes mellitus (DM) on surgical outcomes in degenerative cervical myelopathy (DCM) remains controversial. This prospective multicenter study investigated whether DM affects postoperative neurological recovery, pain, functional outcomes, and health-related quality of life (QOL) following surgery for DCM.
Materials and Methods: A total of 875 patients with DCM were prospectively enrolled between 2018 and 2022 at 10 high-volume centers. Patients underwent standardized evaluations preoperatively and at 2 years postoperatively, including the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) for pain, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the SF-36. Outcomes were compared between patients with DM (n=200) and without DM (n=675) using general linear models adjusted for potential confounders.
Results: Patients with DM were older, had higher body mass index, and more frequently had cardiovascular comorbidities. They also underwent surgery at slightly more levels and more often received posterior decompression without fusion. After adjustment for confounding factors, no significant differences were observed between groups in preoperative or postoperative JOA scores, nor in neurological recovery (ΔJOA: 3.1 vs. 2.7, p=0.35). Improvements in VAS pain scores across all domains were comparable between groups. Similarly, postoperative changes in SF-36 physical and mental component scores did not differ significantly. Multivariable logistic regression analyses demonstrated that DM was not associated with postoperative effectiveness across any JOACMEQ domain, including cervical function, upper or lower extremity function, bladder function, or QOL. The incidence of perioperative complications, including neurological deficits, infection, hematoma, and cerebrospinal fluid leakage, was also similar between groups.
Conclusion: Diabetes mellitus was not associated with inferior neurological recovery, pain relief, functional improvement, or health-related QOL following surgery for DCM. These findings indicate that surgical treatment for DCM can be expected to yield favorable outcomes regardless of diabetic status.