Tatsuya Yamamoto1, Eijiro Okada2, Takehiro Michikawa3, Toshitaka Yoshii4, Tsuyoshi Yamada4, Kei Watanabe5, Keiichi Katsumi5, Akihiko Hiyama6, Masahiko Watanabe6, Yukihiro Nakagawa7, Motohiro Okada7, Teruaki Endo8, Yasuyuki Shiraishi8, Kazuhiro Takeuchi9, Shunji Matsunaga10, Keishi Maruo11, Kenichiro Sakai12, Sho Kobayashi13, Tetsuro Ohba14, Kanichiro Wada15, Junichi Ohya16, Kanji Mori17, Mikito Tsushima18, Hirosuke Nishimura19, Takashi Tsuji20, Masao Koda21, Atsushi Okawa4, Masashi Yamazaki21, Morio Matsumoto1, Kota Watanabe22. 1. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 2. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 3. Dept. of Social Medicine, Toho University, Tokyo, Japan. 4. Dept. of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 5. Dept. of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 6. Dept. of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 7. Dept. of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 8. Dept. of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 9. Dept. of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 10. Dept. of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 11. Dept. of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 12. Dept. of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 13. Dept. of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 14. Dept. of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 15. Dept. of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 16. Dept. of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 17. Dept. of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 18. Dept. of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 19. Dept. of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 20. Dept. of Orthopaedic Surgery, Fujita Health University, Aichi, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 21. Dept. of Orthopaedic Surgery, University of Tsukuba, Ibaraki, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. 22. Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. Electronic address: watakota@gmail.com.
Abstract
BACKGROUND: Patients with diffuse idiopathic skeletal hyperostosis (DISH) are susceptible to spinal column injuries with neurological deterioration. Previous studies indicated that the prevalence of diabetes mellitus (DM) in patients with DISH was higher than that in patients without DISH. This study investigates the impact of DM on surgical outcomes for spinal fractures in patients with DISH. METHODS: We retrospectively evaluated 177 spinal fractures in patients with DISH (132 men and 45 women; mean age, 75 ± 10 years) who underwent surgery from a multicenter database. The subjects were classified into two groups according to the presence of DM. Perioperative complications, neurological status by Frankel grade, mortality rate, and status of surgical site infection (SSI) were compared between the two groups. RESULTS: DM was present in 28.2% (50/177) of the patients. The proportion of men was significantly higher in the DM group (DM group: 86.0% vs. non-DM group: 70.1%) (p = 0.03). The overall complication rate was 22.0% in the DM group and 19.7% in the non-DM group (p = 0.60). Poisson regression model revealed that SSI was significantly associated with DM (DM group: 10.0% vs. non-DM group: 2.4%, Relative risk: 4.5) (p = 0.048). Change in neurological status, mortality rate, instrumentation failure, and nonunion were similar between both groups. HbA1c and fasting blood glucose level (SSI group: 7.2% ± 1.2%, 201 ± 67 mg/dL vs. non-SSI group: 6.6% ± 1.1%, 167 ± 47 mg/dL) tended to be higher in patients with SSI; however, there was no significant difference. CONCLUSIONS: In spinal fracture in patients with DISH, although DM was an associated factor for SSI with a relative risk of 4.5, DM did not negatively impact neurological recovery. Perioperative glycemic control may be useful for preventing SSI because fasting blood glucose level was high in patients with SSI.
BACKGROUND: Patients with diffuse idiopathic skeletal hyperostosis (DISH) are susceptible to spinal column injuries with neurological deterioration. Previous studies indicated that the prevalence of diabetes mellitus (DM) in patients with DISH was higher than that in patients without DISH. This study investigates the impact of DM on surgical outcomes for spinal fractures in patients with DISH. METHODS: We retrospectively evaluated 177 spinal fractures in patients with DISH (132 men and 45 women; mean age, 75 ± 10 years) who underwent surgery from a multicenter database. The subjects were classified into two groups according to the presence of DM. Perioperative complications, neurological status by Frankel grade, mortality rate, and status of surgical site infection (SSI) were compared between the two groups. RESULTS: DM was present in 28.2% (50/177) of the patients. The proportion of men was significantly higher in the DM group (DM group: 86.0% vs. non-DM group: 70.1%) (p = 0.03). The overall complication rate was 22.0% in the DM group and 19.7% in the non-DM group (p = 0.60). Poisson regression model revealed that SSI was significantly associated with DM (DM group: 10.0% vs. non-DM group: 2.4%, Relative risk: 4.5) (p = 0.048). Change in neurological status, mortality rate, instrumentation failure, and nonunion were similar between both groups. HbA1c and fasting blood glucose level (SSI group: 7.2% ± 1.2%, 201 ± 67 mg/dL vs. non-SSI group: 6.6% ± 1.1%, 167 ± 47 mg/dL) tended to be higher in patients with SSI; however, there was no significant difference. CONCLUSIONS: In spinal fracture in patients with DISH, although DM was an associated factor for SSI with a relative risk of 4.5, DM did not negatively impact neurological recovery. Perioperative glycemic control may be useful for preventing SSI because fasting blood glucose level was high in patients with SSI.