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Novel Mini-open Transforaminal Lumbar Interbody Fusion
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Do Diabetic Patients Have Poorer Clinical and Radiological Outcomes Following Minimally Invasive Transforaminal
Yogen Thever1, Liow Ming Han Lincoln2, Cheryl Gatot2
1Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore yogenthever@gmail.com.
International Journal of Spine Surgery
|October 30, 2023
Summary
Patients with diabetes mellitus (DM) show poorer initial outcomes after minimally invasive spinal fusion but achieve comparable long-term results. However, fusion rates may be lower in DM patients compared to non-DM patients.
Area of Science:
- Spine surgery outcomes
- Metabolic disease impact on fusion
- Patient-reported outcome measures
Background:
- Increasing prevalence of diabetes mellitus (DM) among patients undergoing spinal surgery.
- Limited research on patient-reported outcomes (PROs) in DM patients post-minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
- Need to compare outcomes between DM and non-DM patients undergoing MIS-TLIF.
Purpose of the Study:
- To compare PROs, patient satisfaction, and radiological fusion rates between DM and non-DM patients after MIS-TLIF.
- To evaluate the long-term subjective and objective results of MIS-TLIF in patients with and without diabetes.
Main Methods:
- Retrospective analysis of 30 DM patients and 30 matched non-DM controls who underwent single-level MIS-TLIF for degenerative spondylolisthesis.
- Propensity score matching used to control for confounding variables.
- Comparison of Visual Analog Scale (VAS) leg/back pain, Oswestry Disability Index (ODI), SF-36 scores, and patient satisfaction at 1, 3, 6, and 24 months.
- Radiographic fusion assessed using Bridwell grades.
Main Results:
- No significant difference in PROs between DM and non-DM groups at the 2-year follow-up.
- Non-DM patients showed significantly higher rates of achieving minimal clinically important difference for ODI and SF-36 physical component score at 3 months, and for ODI at 6 months.
- Similar patient satisfaction and expectation fulfillment reported in both groups.
- A trend towards lower fusion rates (grade 1 or 2) in DM patients (80.0%) compared to non-DM patients (93.3%), though not statistically significant (P=0.129).
Conclusions:
- Diabetes mellitus patients experience poorer initial patient-reported outcomes following MIS-TLIF.
- Long-term PROs in DM patients become comparable to those in non-DM patients.
- Fusion rates appear to be lower in DM patients compared to non-DM patients after MIS-TLIF.
Keywords:
diabetesfusion rateslumbar fusionminimally invasiveoutcomesquality of lifesatisfactiontransforaminal lumbar interbody fusion
