Diabetes Linked to Higher Complications in Lumbar Spinal Fusion: Study Highlights Structural Changes in Bone Formation

The study found that lumbar spinal fusion procedures are far more likely to fail in individuals with diabetes. Lumbar spinal fusion is a common procedure aimed at stabilizing the spine and alleviating pain by fusing two or more vertebrae.

"Patients undergoing spinal fusion procedures are at a three times higher risk of developing non-union complications if they have diabetes compared to those without diabetes," the researchers reported, noting that surgical outcomes could be improved by controlling blood glucose levels before surgery and exploring therapeutic agents to support new bone formation.

Diabetes predisposes to spine degenerative diseases requiring surgery. However, the statistics on the prevalence of spinal fusion success and clinical indications leading to revision surgery in diabetes are conflicting. Considering this, Claire Wilson, University of Toledo, Toledo, OH, United States, and colleagues aimed to determine the link between diabetes and lumbar spinal fusion complications using a database of patients (n = 552, 45% male, age 54 ± 13.7 years) residing in the same community and receiving care at the same health care facility in a retrospective observational study.

Outcome measures were clinical indications and calculated risk ratio (RR) for revision surgery in diabetes. The research team analyzed paravertebral tissue recovered from a non-union site of nondiabetic and diabetic patients for the microstructure of newly formed bone.

The study led to the following findings:

• Diabetes increased the RR for revision surgery due to non-union complications (2.80) and degenerative processes in adjacent spine segments (2.26).
• In diabetes, the risk of revision surgery exceeded the RR for primary spinal fusion surgery by 44% (2.36 versus 1.64), which was already 2-fold higher than diabetes prevalence in the studied community.
• Micro-CT of bony fragments found in the paravertebral tissue harvested during revision surgery revealed structural differences suggesting that newly formed bone in diabetic patients may be of compromised quality than in nondiabetic patients.

The findings showed that diabetes significantly raises the risk of unsuccessful lumbar spine fusion outcomes needing revision surgery. Diabetes predisposes to the degeneration of adjacent spine segments and pseudoarthrosis at the fusion sites and impacts the structure of newly formed bone needed to stabilize fusion.

Reference:

Wilson, C., Czernik, P. J., Elgafy, H., Khuder, S., Serdahely, K., & Rowland, A. (2024). Diabetes increases risk of lumbar spinal fusion complications: Association with altered structure of newly formed bone at the fusion site. JBMR Plus, 8(6). https://doi.org/10.1093/jbmrpl/ziae053