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Research ArticleLumbar Spine

Do Diabetic Patients Have Poorer Clinical and Radiological Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Yogen Thever, Liow Ming Han Lincoln, Cheryl Gatot and Reuben Soh Chee Cheong
International Journal of Spine Surgery October 2023, 17 (5) 708-714; DOI: https://doi.org/10.14444/8535
Yogen Thever
1 Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
MBBS, MRCS
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  • For correspondence: yogenthever@gmail.com
Liow Ming Han Lincoln
1 Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
BBS, DWD (CAW), MRCSEᴅ, MMᴇᴅ (Oʀᴛʜᴏ), MCI, MFSTEᴅ, FRCSEᴅ (Oʀᴛʜ), FAMS
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Cheryl Gatot
1 Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
MBBS
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Reuben Soh Chee Cheong
1 Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
MBBS, MRCSEᴅ, MMᴇᴅ (Oʀᴛʜᴏ), FRCSEᴅ (Oʀᴛʜ)
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    Figure

    Absolute standardized difference for each variable before and after propensity-score matching. Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; BP, back pain; MCS, mental component score; ODI, Oswestry Disability Index; PCS, physical component score; LP, leg pain; Std, standard; VAS, visual analog scale.

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    Table 1

    Patient demographics and preoperative clinical outcomes.

    CharacteristicsNondiabetics (n = 30)Diabetics (n = 30) P a
    Age, y61.7 ± 10.963.3 ± 8.60.533
    Sex
     Women17 (56.7%)15 (50.0%)0.605
     Men13 (43.3%)15 (50.0%)
    Body mass index28.0 ± 4.728.2 ± 4.30.863
    ASA classification2.3 ± 0.52.3 ± 0.50.786
    Smoking9 (30.0%)5 (16.7%)0.222
    Comorbidities   
     Hypertension19 (63.3%)22 (73.3%)0.405
     Hypercholesterolemia15 (50.0%)23 (76.7%) 0.032
     Ischemic heart disease3 (10.0%)7 (23.3%)0.166
     Stroke1 (3.3%)0 (0.0%)0.313
     Asthma1 (3.3%)3 (10.0%)0.301
    Operative time, min155.2 ± 44.3155.3 ± 31.90.998
    Length of stay, d4.1 ± 1.94.5 ± 3.00.658
    Preoperative outcomes   
     VAS back pain6.8 ± 2.86.5 ± 2.60.740
     VAS leg pain7.1 ± 3.06.7 ± 3.00.552
     Oswestry Disability Index52.9 ± 17.752.6 ± 17.90.945
     SF-36 PCS28.6 ± 8.229.7 ± 9.70.658
     SF-36 MCS47.6 ± 11.044.8 ± 12.00.341
    • Abbreviations: ASA, American Society of Anesthesiologists; MCS, mental component score; PCS, physical component score; SF-36, Short Form-36; VAS, visual analog scale.

    • Note: Data presented as n (%) or mean ± SD. Boldface values indicate statistical significance (P < 0.05).

    • ↵a P value was calculated for each category using χ2 analysis (categorical) or student’s t test (continuous).

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    Table 2

    Comparison of clinical outcomes at different postoperative intervals.

    Comparison at 1 MoNondiabetics
    (n = 30)
    Diabetics (n = 30) P a
    VAS back pain1.1 ± 2.30.4 ± 1.20.142
    VAS leg pain1.2 ± 2.20.7 ± 2.00.301
    ODI30.4 ± 15.431.1 ± 16.60.871
    SF-36 PCS28.9 ± 9.732.5 ± 12.20.211
    SF-36 MCS50.9 ± 11.748.6 ± 12.80.479
    MCID attainment   
     SF-36 PCS (4.9)14 (46.7%)13 (43.3%)0.795
     ODI (12.8)19 (63.3%)18 (60.0%)0.791
     VAS back pain (1.2)24 (80.0%)26 (86.7%)0.488
     VAS leg pain (1.6)24 (80.0%)25 (83.3%)0.739
    Comparison at 3 MoNondiabetics
    (n = 30)
    Diabetics (n = 30) P a
    VAS back pain0.8 ± 2.41.0 ± 2.00.686
    VAS leg pain0.5 ± 1.91.0 ± 2.40.412
    ODI21.0 ± 18.223.8 ± 17.00.553
    SF-36 PCS44.3 ± 9.740.4 ± 11.50.168
    SF-36 MCS55.1 ± 8.353.9 ± 12.10.670
    MCID Attainment   
     SF-36 PCS (4.9)27 (90.0%)16 (53.3%) 0.002
     ODI (12.8)27 (90.0%)20 (66.7%) 0.028
     VAS back pain (1.2)25 (83.3%)24 (80.0%)0.739
     VAS leg pain (1.6)24 (80.0%)25 (83.3%)0.739
    Comparison at 6 MoNondiabetics
    (n = 30)
    Diabetics (n = 30) P a
    VAS back pain0.7 ± 1.81.1 ± 2.30.539
    VAS leg pain0.5 ± 1.41.1 ± 2.50.282
    ODI13.6 ± 14.519.0 ± 15.50.169
    SF-36 PCS45.9 ± 9.943.3 ± 11.10.348
    SF-36 MCS54.9 ± 9.152.0 ± 10.20.248
    MCID attainment   
     SF-36 PCS (4.9)26 (86.7%)20 (66.7%)0.067
     ODI (12.8)29 (96.7%)24 (80.0%) 0.044
     VAS back pain (1.2)25 (83.3%)22 (73.3%)0.347
     VAS leg pain (1.6)26 (86.7%)23 (76.7%)0.317
    Comparison at 2 YNondiabetics
    (n = 30)
    Diabetics (n = 30) P a
    VAS back pain1.1 ± 2.50.8 ± 1.90.650
    VAS leg pain0.4 ± 1.70.8 ± 2.20.469
    ODI12.2 ± 17.915.1 ± 15.30.512
    SF-36 PCS45.7 ± 10.544.7 ± 10.90.704
    SF-36 MCS55.8 ± 10.750.5 ± 12.40.079
    MCID attainment   
     SF-36 PCS (4.9)25 (83.3%)22 (73.3%)0.347
     ODI (12.8)29 (96.7%)25 (83.3%)0.085
     VAS back pain (1.2)25 (83.3%)27 (90.0%)0.448
     VAS leg pain (1.6)25 (83.3%)25 (83.3%)1.000
    • Abbreviations: MCID, minimal clinically important difference; MCS, mental component score; ODI, Oswestry Disability Index; PCS, physical component score; VAS, visual analog scale.

    • Note: Data presented as n (%) or mean ± SD. Boldface values indicate statistical significance (P < 0.05).

    • ↵a P value was calculated for each category using χ2 analysis (categorical) or student’s t test (continuous).

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Do Diabetic Patients Have Poorer Clinical and Radiological Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?
Yogen Thever, Liow Ming Han Lincoln, Cheryl Gatot, Reuben Soh Chee Cheong
International Journal of Spine Surgery Oct 2023, 17 (5) 708-714; DOI: 10.14444/8535

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Do Diabetic Patients Have Poorer Clinical and Radiological Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?
Yogen Thever, Liow Ming Han Lincoln, Cheryl Gatot, Reuben Soh Chee Cheong
International Journal of Spine Surgery Oct 2023, 17 (5) 708-714; DOI: 10.14444/8535
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  • Segmental Lordosis and Disc Height Discrepancies in Lateral Lumbar Interbody Fusion Using Expandable Cages
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Keywords

  • diabetes
  • lumbar fusion
  • minimally invasive
  • transforaminal lumbar interbody fusion
  • fusion rates
  • outcomes
  • satisfaction
  • quality of life

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