Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

Abstract

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

The significance of metabolic disease in degenerative cervical myelopathy: a systematic review

“…The similarity of the cohorts used in 10 of the included studies were deemed unclear ( 32 , 35 , 36 , 49 , 52 , 56 , 58 , 60 , 61 , 86 ), mainly due to a lack of clear selection criteria. Measurement of exposures was mostly adequate, except in five studies ( 36 , 47 , 49 , 52 , 66 ), where the reporting of how exposures were measured were not deemed to be detailed enough. Similarly, seven studies did not include sufficient detail to be able to confidently conclude that exposures were measured in a valid and reliable manner ( 37 , 47 , 49 , 52 , 53 , 55 , 66 ).…”

“…Measurement of exposures was mostly adequate, except in five studies ( 36 , 47 , 49 , 52 , 66 ), where the reporting of how exposures were measured were not deemed to be detailed enough. Similarly, seven studies did not include sufficient detail to be able to confidently conclude that exposures were measured in a valid and reliable manner ( 37 , 47 , 49 , 52 , 53 , 55 , 66 ). Identification of confounding factors (e.g., sex, age and duration of symptoms) was mostly adequate, except in six studies that appeared to miss key confounders ( 47 , 52 , 56 , 58 , 60 , 61 ), most commonly due to lack of complete exclusion criteria, and two studies that appeared to be missing most confounders ( 32 , 49 ).…”

“…Identification of confounding factors (e.g., sex, age and duration of symptoms) was mostly adequate, except in six studies that appeared to miss key confounders ( 47 , 52 , 56 , 58 , 60 , 61 ), most commonly due to lack of complete exclusion criteria, and two studies that appeared to be missing most confounders ( 32 , 49 ). Strategies to deal with confounders was performed to a lower quality, with 13 studies deemed unclear ( 38 , 39 , 50 , 52 , 53 , 55 , 58 , 60 , 61 , 66 , 73 , 77 , 79 ), and four studies deemed inadequate ( 32 , 47 , 48 , 56 ), most commonly due to a lack of a multivariate regression analysis. The cohorts were deemed either free of the outcome at the start of all studies or this criteria was not applicable, if for example the outcome was improvement in neurological status.…”

Comparison of Postoperative Complications and Outcomes in Anterior Cervical Spine Surgery

“…Risk factors for postoperative upper airway complications include blood loss >300 mL, surgery on 4 or more vertebral bodies, including C4, and operation time >5 hours 40,41 . Incidences of hoarseness reportedly range from 0% to 13.7% for entire anterior approach surgeries and 0.3%–4.6% specifically for OPLL surgeries 15,42–44 . Surgical interventions involving C2/3 and C3/4 segments, along with prolonged operation times, increase the likelihood of postoperative hoarseness 44 .…”

Preoperative Symptom Duration Influences Neurological Recovery and Patient Reported Outcome Measures After Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament

“…Patients with mild symptoms can be treated conservatively, but patients with progressive myelopathy frequently require surgical intervention. 2 Previous research has reported that age, 3 preoperative neurological score, 4 comorbidities, 5 surgical approach, 6,7 high signal intensity on magnetic resonance imaging, 8,9 and other factors are associated with surgical outcomes for the treatment of cervical OPLL. 10 However, the effect of symptom duration on postoperative outcomes for cervical OPLL and the threshold of symptom duration for favorable recovery have not been adequately studied.…”