요추부 척추관 협착증과 당뇨병 : 수술적 치료의 결과 Comparison of Surgical Outcome = Lumbar Spinal Stenosis and Diabetes Mellitus

다국어 초록 (Multilingual Abstract)

Study Design : This retrograde study was designed to compare the clinical features and postoperative clinical results of diabetic and non-diabetic patients who had undergone decompression and postero-lateral fusion with instrumentation.
Objective : To determine whether diabetes affected the outcome of surgery and to identify the clinical features associated with a poor outcome
Summary of Background Data : Symptoms of peripheral angiopathy and neuropathy as longterm complications of diabetes closely mimic those of lumbar stenosis and there may be a risk of inappropriate surgical intervention in patients with both diabetes and spinal stenosis. In the presence of diabetes, a poor surgical outcome might be expected. But only a few literatures have been documented.
Materials and Methods : We reviewed 21 diabetic(mean age 58.2 years) and 21 non-diabetic patients(mean age 61.3 years) who had undergone decompression and postero-lateral fusion with instrumentation for lumbar spinal stenosis at a mean of 32 months after operation by reviewing the medical records such as clinical symptoms and results of objective examination(including electrophysiologic study)
Results : The preoperative symptoms were similar in the two groups except that abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. The level of decompression, co-morbidity rate, and intra-operative blood loss were similar in two groups, too. Nerve-conduction velocity was lowered in 66.7% of the diabetic and in 25% of the non-diabetic patients. Polyneuropathy, which are highly suspicious of diabetic neuropathy was detected 46.7% in only diabetic group. The long-term result was excellent or good for thirteen(61.9%) of the twenty-one diabetic patients and for nineteen(90.5%) of the twenty-one nondiabetic patients.
Conclusions : Thus diabetic patients who have spinal stenosis cannot be expected to have same clinical outcome as non-diabetic patients, which is consistent with the general belief or impression. Therefore, the selection of patient according to clinical and electrophysiologic findings would be the most important factor i n determining the rate of success of surgical treatment.