Diabetes Mellitus and the Development of Lumbar Canal Stenosis: Is There Any Relevance?

Abstract

Study Design: Retrospective study.Purpose: To assess the relationship between the severity of lumbar canal stenosis (LCS) and type-II diabetes mellitus (DM).Overview of Literature: DM is a multiorgan disorder that has an effect on all types of connective tissues. LCS is a narrowing of the spinal canal with nerve root impingement that causes neurological claudication and radiculopathy. Identification of the risk factors of LCS is key in the prevention of its onset or progression.Methods: LCS patients were divided into three groups as per DM status: group A without DM (n=150); group B patients with well-controlled DM; and group C patients with uncontrolled DM. Groups B and C were subdivided into group B1: patients with DM with a duration of ≤10 years (n=76), group B2: DM with duration of >10 years (n=68), group-C1 DM duration ≤10 years (n=56), and group C2 DM duration >10 years (n=48). The severity of LCS was evaluated using the Swiss Spinal Stenosis Scale (SSSS) and Modified Oswestry Disability score (MODS). Operated patients ligamentum flavum sent for histological staining and quantitative immunofluorescence analysis.Results: The demographic data of groups did not show any difference except in age. There was no difference between the mean SSSS and MODS of groups A and B1. Groups B2, C1, and C2 had higher average SSSS and MODS than group A (p<0.05). Groups B2 and C2 had higher SSSS and MODS than groups B1 and C1. Group C1 and C2 had higher scores than groups B1 and B2 (p<0.05). The severity of LCS was significantly related to the duration of DM in groups B and C (p<0.05). Uncontrolled and longer duration of DM had significant elastin fibers loss and also higher rate of disk apoptosis, high matrix aggrecan fragmentation, and high disk glycosaminoglycan content.Conclusions: Longer duration and uncontrolled diabetes were risk factors for LCS and directly correlate with the severity of LCS.

Diabetes Mellitus and Poor Glycemic Control Are Associated With a Higher Risk of Lumbar Spinal Stenosis

“…Regarding the impact of DM duration on the likelihood of LSS diagnosis, our findings align with other studies that suggest a correlation between prolonged exposure to DM and an early onset of DM diagnosis with an elevated risk of DM-related complications 21,24,25 In alignment with our findings, Iderberg et al 26 identified an association between various socioeconomic factors (such as country of birth, educational level, social welfare, and employment status) and the outcomes of LSS surgery 15 . In addition, our observation of a diminished likelihood of LSS in individuals with higher physical activity levels corresponds with prior research, suggesting that increased physical activity can improve pain and function in this population 27 .…”

“…Several studies suggested that DM may contribute to the pathogenesis of LSS. 9,10,21,22 In this large cohort study, we investigated the epidemiological connection between DM and LSS. We also conducted an analysis of additional risk factors for LSS and examined the mortality rates within the study populations.…”

“…DM is a multisystemic disease affecting numerous types of connective tissues, including bone and cartilage, and is associated with several musculoskeletal manifestations. It is estimated to affect 537 million adults worldwide, 20 and due to the increase in childhood obesity, the prevalence of DM might continue to increase substantially. Several studies suggested that DM may contribute to the pathogenesis of LSS 9,10,21,22 …”

“…It is estimated to affect 537 million adults worldwide, 20 and due to the increase in childhood obesity, the prevalence of DM might continue to increase substantially. Several studies suggested that DM may contribute to the pathogenesis of LSS 9,10,21,22 …”

Time Trends and Sex Differences in the Association between Diabetes and Chronic Neck Pain, Chronic Low Back Pain, and Migraine. Analysis of Population-Based National Surveys in Spain (2014–2020)

“…Among the possible causes that can explain the association of spinal pain (NP and/or LBP) with diabetes are that people with diabetes have an increased risk of cartilage inflammation, loss of muscle strength, spinal stenosis, and degenerative intervertebral disc (IVD) disease [ 6 , 7 , 8 , 13 , 14 ]. The arguments for a spurious association between spinal pain and diabetes include the confounding effect of obesity, depression, and sedentarism, conditions more frequent among people with diabetes than without [ 6 , 7 , 8 ].…”