Diabetes Mellitus as a Risk Factor for the Development of Lumbar Spinal Stenosis
Diabetes mellitus is a multi-organ disorder affecting many types of connective tissues, including bone and cartilage. Certain skeletal changes are more prevalent in diabetic patients than in non-diabetic individuals. A possible association of diabetes mellitus and lumbar spinal stenosis has been raised.
To compare the prevalence of diabetes mellitus in patients with spinal stenosis, degenerative disk disease or osteoporotic vertebral fractures.
A cross-sectional analysis was performed of 395 consecutive patients diagnosed with spinal stenosis, degenerative disk disease or osteoporotic vertebral fractures. All the patients were examined by one senior author in the outpatient orthopedic clinic of a large general hospital between June 2004 and January 2006 and diagnosed as having lumbar spinal stenosis (n=225), degenerative disk disease (n=124), or osteoporotic vertebral fractures (n=46).
The prevalence of diabetes mellitus in the three groups (spinal stenosis, osteoporotic fracture, degenerative disk disease) was 28%, 6.5% and 12.1%, respectively, revealing a significantly higher prevalence in the spinal stenosis group compared with the others (P=0.001). The higher prevalence of diabetes in the stenotic patients was unrelated to the presence of degenerative spondylolisthesis.
There is an association between diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis.
Available from: Chi Heon Kim
- "Without detailed clinical and radiological information, the present result may indicate that diabetic patients were not more likely than nondiabetic patients to experience major problems requiring reoperation during the 90-day postoperative period; however, the etiology of the postoperative problems could not be specified. Previous prospective and retrospective studies showed that the improvement of pain or function was higher in nondiabetic patients than in diabetic patients after surgery for lumbar degenerative disease       . Although the primary end point was different from that of previous studies, we tried to show an ongoing effect of diabetes on surgical outcome that was not addressed in previous reports. "
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ABSTRACT: Diabetes is present in 5 - 20 % of patients undergoing spine surgeries and is a known risk factor for reoperation. Considering the chronicity of diabetes, its influence on the reoperation rate may differ over time.
To present the relationship between diabetes and the reoperation rate over time.
Retrospective cohort study PATIENT SAMPLE: A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar degenerative disease in 2003 (n = 34,918).
The primary end-point was any type of second lumbar surgery after fusion surgery (n = 4,792) or decompression surgery (n = 30,126) during the early (0 - postoperative 90 days), short-term (91 - 365 days) and mid-term (1 - 6 years) periods.
All patients were followed-up until Dec. 2008. Cox proportional hazards regression modeling was used to assess the adjusted reoperation rates in the diabetic patients.
The incidence of diabetes in the present cohort was 24.5 % in the fusion group and 16.9 % in the decompression group. Overall, reoperation was performed in 13.2 % (631/4,792) of the patients after fusion surgery and in 14.0 % (4,214/30,126) of the patients after decompression surgery. After fusion surgery, diabetes did not make a significant difference in the reoperation rate during the entire follow-up period. After decompression surgery, the reoperation rate was not different during postoperative month 3, but diabetic patients showed a 1.2 - 1.4-times higher reoperation rate during postoperative 3 months to 5 years (p < 0.01).
The study did not find a relationship between diabetes at the time of surgery and the reoperation rate during the early postoperative period. Thereafter, the reoperation rate was not higher after fusion surgery in diabetic patients, but it was higher after decompression surgery.
Copyright © 2015 Elsevier Inc. All rights reserved.
Available from: David R Seaman
- "Osteoarthritis is also promoted by the metabolic syndrome [32-35]. Patients with type 2 diabetes have reduced mobility across all joints tested compared to age/weight matched controls , and are more likely to develop lumbar stenosis compared to non-diabetics [37,38]. Type 2 diabetes also increases the risk of expressing disc herniation in both the cervical and lumbar spines [39,40]. "
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Back pain is one of the most common complaints that patients report to physicians and two-thirds of the population has an elevated body mass index (BMI), indicating they are either overweight or obese. It was once assumed that extra body weight would stress the low back and lead to pain, however, researchers have reported inconsistencies association between body weight and back pain. In contrast, more recent studies do indicate that an elevated BMI is associated with back pain and other musculoskeletal pain syndromes due to the presence of a chronic systemic inflammatory state, suggesting that the relationship between BMI and musculoskeletal pains be considered in more detail.
To describe how an elevated BMI can be associated with chronic systemic inflammation and pain expression. To outline measurable risk factors for chronic inflammation that can be used in clinical practice and discuss basic treatment considerations.
Adiposopathy, or “sick fat” syndrome, is a term that refers to an elevated BMI that is associated with a chronic systemic inflammatory state most commonly referred to as the metabolic syndrome. The best available evidence suggests that the presence of adiposopathy determines if an elevated BMI will contribute to musculoskeletal pain expression. It is not uncommon for physicians to fail to identify the presence of adiposopathy/metabolic syndrome.
Patients with an elevated BMI should be further examined to identify inflammatory factors associated with adiposopathy, such as the metabolic syndrome, which may be promoting back pain and other musculoskeletal pain syndromes.
Available from: Ali Yavuz Karahan
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ABSTRACT: Difficulty in walking, pain, numbness and other symptoms may occur in geriatric patients during walking, depending on various pathologies of waist, hips, knees and other areas. However claudication is an important symptom that is watched in specific clinic tables. That often appears by walking and it is described as not localized pain in one or two legs, weakness, numbness, parestesia and cramp by patients. Vascular claudication, especially monitored in peripheral arterial disease and neurogenic claudication monitored in lumbar spinal stenosis are the most important and initial clinical symptoms of these statements. In the presence of lower extremity pain in geriatric patients there are many diseases to be considered in the differential diagnosis. Therefore, patients with claudication should not be neglected as defined for the differential diagnosis and a guiding symptom. In this text, we present a case which described a variable claudication and diagnosed with lumber spinal stenosis and peripheral artery disease the aim of rewiewing the process from symptoms to diagnosis.
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