Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus

Transcription

1 Abstract Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus Sang Wook Bae, M.D., Ho Yoon Kwak, M.D., Baik Yong Song, M.D., Nam Hong Choi, M.D., Ho Jun Kim, M.D. Department of Orthopedic Surgery, Nowon Eulji Hospital, Eulji University School of Medicine Study Design : This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. Summary of Literature Review : There are controversies in the treatment results of diabetic patients. Objective : To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. Materials and Methods : We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, In all patients, duration of symtoms, sensory and motor deficits, co-morbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. Results : Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. Conclusion : The outcome of surgery was similary successful in the two groups. Key Words : Lumbar spinal stenosis, Diabetes mellitus, Decompression and arthrodesis Address reprint requests to Sang Wook Bae, M.D. Department of Orthopaedic Surgery, Nowon Eulji Hospital #280-1 Hagye-dong, Nowon-ku, Seoul, Korea Tel : , 8260 Fax : , bsw2402@eulji.or.kr

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3 Table 1. Clinical Features Diabetic Non-diabetic Symptom duration(yr) < 1 14(52%) 13(48%) 1-3 7(26%) 9(33%) > 3 6(22%) 5(19%) Claudication(m) < (48%) 13(48%) (30%) 7(26%) > 300 3(11%) 3(11%) Neurologic deficit sensory 13(48%) 14(52%) motor 11(41%) 10(37%) Co-morbidity 0-2 8(30%) 13(48%) (52%) 10(37%) > 6 5(18%) 4(15%) Follow-up(yr) 1-2 9(33%) 8(30%) (41%) 10(37%) > 3 7(26%) 9(33%)

4 Table 2. Radiographic fusion Lenke grade Diabetic Non-diabetic A 13(48%) 15(55%) B 8(30%) 8(30%) C 4(15%) 3(11%) D 2(7%) 1(4%) Total 27(100%) 27(100%) Table 3. Clinical Results Diabetic Non-diabetic Excellent 4(15%) 5(19%) Good 15(56%) 16(59%) Fair 6(22%) 5(18%) Poor 2(7%) 1(4%) Total 27(100%) 27(100%) Table 4. Relationship of clinical result and duration of diabetes < >20(Yrs) Excellent Good Fair Poor Total Table 5. Postoperative Complications Diabetic Non-diabetic Meralgia paresthetica 3 2 Paralytic ileus 2 2 Urination difficulty 1 2 Infection superficial 1 1 deep

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