Asian Spine Journal (Jun 2022)

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

  • Ghanshyam Kakadiya,
  • Kalpesh Saindane,
  • Yogesh Soni,
  • Kushal Gohil,
  • Akash Shakya,
  • Mohhamad Umair Attar

DOI
https://doi.org/10.31616/asj.2020.0566
Journal volume & issue
Vol. 16, no. 3
pp. 326 – 333

Abstract

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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.

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