Lumbar discectomy and the diabetic patient: incidence and outcome

doi:10.1054/jocn.2000.0682

Journal of Clinical Neuroscience

Volume 8, Issue 1, January 2001, Pages 10-13

https://doi.org/10.1054/jocn.2000.0682 Get rights and content

Abstract

Medical records of 363 patients who had a diagnosis of lumbar disc disease and were managed by a posterior approach lumbar discectomy over a 7 year period were reviewed: 33 patients had a preoperative diagnosis of diabetes, an incidence in this patient population of 9.1%. The results for these 33 patients who had a diagnosis of diabetes mellitus were compared with those of 33 age and sex matched nondiabetic (control) patients who had a similar operative approach. Twenty-five of the diabetic and 28 of t he control patients were available for long term follow up. The results were positive (good to excellent) for 24 of the 28 (86%) control patients and 15 of the 25 (60%) diabetic patients. Seven of the 25 (28%) diabetic patients had reoperation for recurr ent disc herniation at the same level following the initial procedure compared with one of the 28 (3.5%) control patients.

References (18)

JM Simpson et al.
An H S. The results of operations on the lumbar spine in patients who have diabetes mellitus
J Bone Joint Surg Am
(1993)
M Spengler D et al.
Patient selection for lumbar discectomy. An objective approach
Spine
(1979)
V Graver et al.
Seven-year clinical follow-up after lumbar disc surgery; results and predictors of outcome
BJ of Neurosurgery
(1999)
RD Gelber et al.
Quality of life assesment in clinical trials
Ryan, B, F, Joiner, B, L, Ryan, T, A, 1985, 186,...
Pearson, J C G, Turton, A, Statistical methods in environmental health, London, Chapman and Hall, 1993, 93,...
Circular on Epidemiology by ACT Department of Health. Diabetes Australia, July...
G Cinotti et al.
Lumbar spinal stenosis and diabetes. Outcome of surgical decompression
J Bone Joint Surg Br
(1994)
O Airaksinen et al.
Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis
Spine
(1997)

There are more references available in the full text version of this article.

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^f1: Correspondence to: R. L. Newcombe, Director, Neurosurgical Unit, Canberra Clinical School of The University of Sydney, The Canberra Hospital, Woden ACT, 2605 Australia.

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MiscellaneousLumbar discectomy and the diabetic patient: incidence and outcome

Abstract

An H S. The results of operations on the lumbar spine in patients who have diabetes mellitus

J Bone Joint Surg Am

Patient selection for lumbar discectomy. An objective approach

Spine

Seven-year clinical follow-up after lumbar disc surgery; results and predictors of outcome

BJ of Neurosurgery

Quality of life assesment in clinical trials

Lumbar spinal stenosis and diabetes. Outcome of surgical decompression

J Bone Joint Surg Br

Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis

Spine

Miscellaneous
Lumbar discectomy and the diabetic patient: incidence and outcome