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People with Diabetes Face Greater Risks after Lumbar Fusion

Studies show that people with diabetes heal more slowly compared with patients who don't have diabetes. They also have more problems after surgery. This is true whether the patient with diabetes is insulin-dependent or not.

Spine surgery is no exception. Doctors know there is greater risk of both major and minor problems for the patient with diabetes having a lumbar (low back) decompression. This operation removes a portion of the damaged disc. The idea is to take painful disc pressure off the spinal nerve root.

Sometimes a longer operation is needed. The doctor may have to fuse the spine at one or more levels. Metal plates and screws may be used to hold the spine steady until the fusion is complete. How can diabetes affect a person's results after lumbar decompression and fusion surgery?

That's the subject of this study. The authors started out thinking that more surgery means more complications during and after the operation. They compared a group of 94 patients with diabetes to a group of 43 patients without diabetes. Both groups had lumbar decompression surgery followed by spinal fusion.

The authors were right. Patients with diabetes had a 53 to 56 percent increase in problems. Patients without diabetes only had a 21 percent increase. They found that differences were not based on age, gender, or tobacco use. Larger body mass (height and weight) did matter.

Problems were divided into major and minor complications. Major problems were defined as life-threatening. Minor problems had to be addressed, but they didn't change the patient's treatment after the operation. Problems included wound infections, nonunion (failure to form a solid bone fusion), urinary tract infections, and nerve damage.

The authors report no difference among patients with diabetes. The results were the same whether people were receiving insulin or not. However, these two groups had worse results than the group of patients without diabetes. The control group had fewer problems of any kind.

Researchers conclude that doctors should warn patients with diabetes of the increased risk with this kind of operation. Longer time in the operating room and more levels of fusion increase the risk even more.

References: Steven D. Glassman, MD, et al. Perioperative Complications of Lumbar Instrumentation and Fusion in Patients with Diabetes Mellitus. In The Spine Journal. November/December 2003. Vol. 3. No. 6. Pp. 496-501.

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