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  • Impact of Diabetes on Symptoms and Treatment Outcomes in Patients with Cervical Spondylotic Myelopathy: The Results of the AOSpine North America Multi-Center Prospective Study

    Final Number:

    Paul M. Arnold MD; Branko Kopjar MD; Michael G. Fehlings MD PhD FRCSC FACS; Sangwook Yoon MD; Alexander R. Vaccaro MD; Darrel S. Brodke MD; Christopher I. Shaffrey MD, FACS; Eric J. Woodard MD; Robert J. Banco MD; Jens Chapman MD; Michael Janssen MD; Rick Sasso MD; Christopher Bono MD; Mark B. Dekutoski MD; Ziya L. Gokaslan MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Diabetes and its associated neuropathy may impact the severity of symptoms and the outcomes of treatment in patients with cervical spondylotic myelopathy.

    Methods: A total of 278 patients with clinically symptomatic CSM were enrolled at 12 North American sites in a prospective cohort study. Of these, 42 (15%) had diabetes at baseline. We compared pre-surgery symptoms and treatment outcomes between the patients with and without diabetes using univariate and multivariate models adjusting for demographics, comorbidties, baseline mJOA, Neck Disability Index, SF36v2, Nurick Score, history of CSM, source of stenosis, spinal level, and surgical approach.

    Results: Diabetic patients were older (60 vs 56 years, P < .005), less likely to smoke (14% vs. 28%, P < .05) and more likely to be social security recipient (52% vs 36%, P < .05). They presented with a higher Nurick grade (4.4 vs 4.1, P < .05). There were no differences in mJOA, NDI and SF36v2 at the presentation. Overall, there was a significant improvement in all outcome parameters at 12 months (presented elsewhere). We found no differences in the level of improvement between the patients with and without diabetes in any of the outcome parameters. These findings remained stable after adjustment for multiple baseline characteristics through multivariate statistical modeling.

    Conclusions: Except for a higher baseline Nurick score, diabetes does not seem to affect symptom severity at the time of surgery. More importantly, outcomes of surgical treatment are similar in patients with and without diabetes. We conclude that surgical treatment is effective and recommended for patients with diabetes who have symptomatic spondylotic myelopathy.

    Patient Care: We show that diabetes does not impact outcomes of CSM. Surgery should be offered to patients with diabetes and CSM.

    Learning Objectives: Diabetes is a significant comorbidity in all patients. Diabetic neuropathy puts potential risk on recovery and success in surgery from CSM.


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