Article

Outcomes of decompression surgery for lumbar spinal stenosis in elderly diabetic patients.

Frieda Schiff Warburg Geriatric Center, Dora, Netanya, Israel.
European Spine Journal (impact factor: 1.97). 02/2004; 13(1):32-7. DOI:10.1007/s00586-003-0643-7 pp.32-7
Source: PubMed

ABSTRACT The purpose of this study was to assess and compare the outcome of surgical decompression for spinal stenosis in diabetic and non-diabetic elderly patients. This is a retrospective chart analysis conducted in a university affiliated referral hospital. The participants were consecutive patients, age 65 and older, undergoing laminectomy for spinal stenosis during 1990-2000. We assessed patients' clinical and demographic data, procedures, perioperative complications, preoperative and postoperative pain intensity, basic activities of daily living (BADL), patients' satisfaction, the need for repeated surgery, and overall mortality. A total number of 62 elderly diabetic group (DG) patients undergoing decompression surgery for spinal stenosis were compared with a sex and age-matched non-diabetic control group (CG) at baseline, and a mean of 40.3 months thereafter. We found that the DG patients had more pain ( p=0.042), and suffered more frequently from neurogenic claudication ( p=0.0018), motor weakness ( p=0.021) and numbness of the affected limb ( p=0.0069) than the CG patients. Nocturnal pain was reported in 24% of the DG patients. Pain relief was successfully achieved in both groups ( p<0.001), but the patients' satisfaction was greater in the non-diabetic patients ( p=0.0067). Revision surgery was more frequently performed in the DG than the CG (non-significant difference), and the time interval for such a second intervention was shorter ( p=0.04) in the DG. A higher rate of post-operative complications was observed in the DG ( p<0.0001). It is concluded that surgical treatment of elderly diabetic patients suffering from spinal stenosis improves BADL and ameliorates pain, but the results remain worse than those observed in non-diabetics. The outcome of diabetic patients depends upon the presence of other comorbidities, concurrent diabetic neuropathy, duration of diabetes and insulin treatment. Successful postoperative pain reduction remained the strongest factor associated with patients' satisfaction.

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Keywords

62 elderly diabetic group
 
age-matched non-diabetic control group
 
ameliorates pain
 
CG patients
 
concurrent diabetic neuropathy
 
DG patients
 
diabetic patients
 
elderly diabetic patients
 
neurogenic claudication
 
Nocturnal pain
 
non-diabetic elderly patients
 
non-diabetic patients
 
patients' satisfaction
 
perioperative complications
 
post-operative complications
 
postoperative pain intensity
 
referral hospital
 
retrospective chart analysis
 
Successful postoperative pain reduction
 
surgical decompression