The influence of diabetes mellitus on lumbar intervertebral disk herniation

doi:10.1016/j.surneu.2006.01.019

Surgical Neurology

Volume 66, Issue 2, August 2006, Pages 152-154

https://doi.org/10.1016/j.surneu.2006.01.019 Get rights and content

Abstract

Background

It has recently been proven that smoking has a negative influence on lumbar disk herniation. This is probably due to microangiopathy. Our purpose was to find out if patients operated on for lumbar disk disease also have an increased incidence of diabetes mellitus. We have also examined if this increased incidence could be the result of diagnostic uncertainties (diabetic neuropathy operated as lumbar disk disease).

Methods

This is a prospective study. One hundred two patients operated on in our department for lumbar disk herniation were compared with 98 patients of the same age who were admitted for elective surgery and did not take cortisone. History for diabetes mellitus, blood glucose, and glycated hemoglobin were examined. χ² test was used for statistical analysis. We have also compared the results of the diabetics and nondiabetic patients operated on for lumbar disk disease.

Results

There was a statistically significant increased incidence of diabetes mellitus in patients operated on for lumbar disk disease. There was no difference in the results at 3 months of the 2 groups of patients operated on for lumbar disk disease.

Conclusions

Patients operated on for lumbar disk disease have a statistically significant increased incidence of diabetes mellitus compared with similar patients operated on for other reasons. This difference cannot be explained by diagnostic uncertainties because if patients with diabetic polyneuropathy were wrongly operated on for lumbar disk disease, their results would not be as good as those of the other patients operated on for lumbar disk disease. Diabetes mellitus must be a predisposing factor in patients operated on for lumbar disk disease.

Introduction

Section snippets

Materials and methods

This is a prospective study.

We have studied 102 patients operated on in series in our department during the period of 1997 to 1999 for lumbar disk herniation. Reoperations were excluded. These patients had either radiculopathy not responding to conservative treatment for more than 1 month and less than 6 months, or muscle strength diminution to the distribution of a nerve root compressed by herniated disk. Neuroradiologic diagnosis was done by MRI scan or CT myelography. Electromyographic and

Results

The mean age for the first group was 52 years and for the second group 55 years.

There is a statistically significant increased incidence of diabetic patients operated on for symptomatic lumbar disk compared with those operated on for other reasons (Table 1). The incidence of diabetes mellitus was 32% in the patients who underwent surgery and 13% in those who did not.

Fifty-five (80%) of 69 nondiabetics and 25 (76%) of 33 diabetic patients had good results at 3 months. There was no statistical

Discussion

Many predisposing factors for lumbar disk disease have been found.

Intrinsic defects of the disk due to genetic predisposition have been examined in cases of juvenile discogenic disease [7]. Family history has a predominating role as a risk factor for spinal disk degeneration disease [12]. Classic twin study methods [18] and case control studies [19] have also been used with positive results for genetic influence.

Risk factors are, among others, age [6], [12], smoking [1], [10], [12], [13],

Conclusions

Diabetes mellitus seems to be a predisposing factor for the development of significant lumbar disk disease that needs to be operated on.

References (24)

R.J. Mobbs et al.
Lumbar discectomy and the diabetic patient: incidence and outcome
J Clin Neurosci
(2001)
H.S. An et al.
Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls
J Spinal Disord
(1994)
J. Frymoyer
J.W. Frymoyer et al.
Risk factors in low back pain
J Bone Joint Surg
(1983)
A. Gikas et al.
Prevalence of diabetes and impaired glucose regulation in 45- to 64-year-old individuals in three areas of Finland
Diabet Med
(2005)
N.M. Hadler
Regional back pain
N Engl J Med
(1986)
G. Hassett et al.
Risk factors for progression of lumbar spine disc degeneration: the Chingford Study
Arthritis Rheum
(2003)
K.B. Heithoff et al.
Juvenile discogenic disease
Spine
(1994)
L.F. Hirsh
Diabetic polyradiculopathy simulating lumbar disc disease. Report of four cases
J Neurosurg
(1984)
S. Holm et al.
Immediate effects of cigarette smoke on the nutrition of the intervertebral disc of the pig
Orthop Trans
(1984)

J.L. Kelsey et al.

Acute prolapsed lumbar disc

Spine

(1984)

M. Kurunlahti et al.

Association of atherosclerosis with low back pain and the degree of disc degeneration

Spine

(1999)

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SpineThe influence of diabetes mellitus on lumbar intervertebral disk herniation

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

J Clin Neurosci

Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls

J Spinal Disord

Risk factors in low back pain

J Bone Joint Surg

Prevalence of diabetes and impaired glucose regulation in 45- to 64-year-old individuals in three areas of Finland

Diabet Med

Regional back pain

N Engl J Med

Risk factors for progression of lumbar spine disc degeneration: the Chingford Study

Arthritis Rheum

Juvenile discogenic disease

Spine

Diabetic polyradiculopathy simulating lumbar disc disease. Report of four cases

J Neurosurg

Immediate effects of cigarette smoke on the nutrition of the intervertebral disc of the pig

Orthop Trans

Acute prolapsed lumbar disc

Spine

Association of atherosclerosis with low back pain and the degree of disc degeneration

Spine

Spine
The influence of diabetes mellitus on lumbar intervertebral disk herniation