Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients

There have been a few reports on the surgical outcomes of cervical myelopathy in diabetic patients; however, those studies included ossification of the posterior longitudinal ligament. This study investigated whether surgical outcome of expansive laminoplasty (ELAP) for diabetic patients with cervical spondylotic myelopathy (CSM) differs from that for non-diabetic patients and determined prognostic factors in diabetic patients. We retrospectively reviewed 78 patients with CSM after excluding the cases with other medical conditions, which could affect surgical outcome from 222 consecutive patients who had undergone ELAP between 2000 and 2008 in our hospital. The patients were divided into two groups: diabetic patients (Group 1) and non-diabetic patients (Group 2). We evaluated differences in age, gender, pre- and postoperative Japanese Orthopaedic Association (JOA) score, recovery rate (RR), symptom duration, and postoperative complications between the two groups. In Group 1, the correlation between RR and factors indicating the severity of diabetes mellitus was assessed. There were 13 patients in Group 1 and 65 in Group 2. There was no significant difference in age, gender, JOA score before or after surgery, or symptom duration between the two groups. Group 1 showed poorer recovery of sensory and motor function in the lower extremities. A negative correlation was observed between RR and the preoperative hemoglobin A(1c) (HbA(1c)) level in Group 1. Diabetic patients experienced benefits from ELAP similar to non-diabetic patients. A negative correlation between RR and preoperative HbA(1c) level suggests that strict blood sugar control is recommended before surgery.