Diabetes Mellitus and the Development of Lumbar Canal Stenosis: Is There Any Relevance?

Abstract

Study design: Retrospective study.

Purpose: To assess the relationship between the severity of lumbar canal stenosis (LCS) and type-II diabetes mellitus (DM).

Overview of literature: DM is a multiorgan disorder that has an effect on all types of connective tissues. LCS is a narrowing of the spinal canal with nerve root impingement that causes neurological claudication and radiculopathy. Identification of the risk factors of LCS is key in the prevention of its onset or progression.

Methods: LCS patients were divided into three groups as per DM status: group A without DM (n=150); group B patients with well-controlled DM; and group C patients with uncontrolled DM. Groups B and C were subdivided into group B1: patients with DM with a duration of ≤10 years (n=76), group B2: DM with duration of >10 years (n=68), group-C1 DM duration ≤10 years (n=56), and group C2 DM duration >10 years (n=48). The severity of LCS was evaluated using the Swiss Spinal Stenosis Scale (SSSS) and Modified Oswestry Disability score (MODS). Operated patients ligamentum flavum sent for histological staining and quantitative immunofluorescence analysis.

Results: The demographic data of groups did not show any difference except in age. There was no difference between the mean SSSS and MODS of groups A and B1. Groups B2, C1, and C2 had higher average SSSS and MODS than group A (p<0.05). Groups B2 and C2 had higher SSSS and MODS than groups B1 and C1. Groups C1 and C2 had higher scores than groups B1 and B2 (p<0.05). The severity of LCS was significantly related to the duration of DM in groups B and C (p<0.05). Uncontrolled and longer duration of DM had significant elastin fibers loss and also higher rate of disk apoptosis, high matrix aggrecan fragmentation, and high disk glycosaminoglycan content.

Conclusions: Longer duration and uncontrolled diabetes were risk factors for LCS and directly correlate with the severity of LCS.

Keywords: Diabetes mellitus; Lumbar canal stenosis; Modified Oswestry Disability score; Swiss Spinal Stenosis Scale.

Fig. 1

(A–C) Magnetic resonance imaging and microscopy images of a 58-year-old non-diabetic female showing normal elastin fibers. (D–F) A 60-year-old female with uncontrolled diabetes mellitus (DM) of longer duration and lumbar canal stenosis shows severe lumbar canal stenosis with moderate loss of elastin fibers.

Fig. 2

T2-weighted the lumbar spine magnetic resonance imaging of a 56-year-old controlled diabetic female. (A) Mid-sagittal view shows L4–L5 disc budge with stenosis. (B–E) Axial scan of L4–L5 and L5–S1 shows disc bulge, ligament flavum hypertrophy, and central with lateral recess stenosis.

Fig. 3

T2-weighted the lumbar spine magnetic resonance imaging of a 58-year-old uncontrolled diabetic female. (A) Mid-sagittal view shows lumbar degenerative disc with L4–L5and L5–S1 disc budge with stenosis. (B–E) Axial scan shows L4–L5 and L5–S disc bulge, severe ligament flavum hypertrophy, facet joint degeneration-cyst, and severe central with lateral recess stenosis.