According to the Centers for Disease Control and Prevention, 38.4 million people in the U.S. have diabetes, 97.6 million people 18 or older have prediabetes and 27.2 million people 65 and older have prediabetes.1 As our population stands at roughly 336,377,915 people, those in the above categories represent nearly half of the country.2
98,000 Patient Study Links Diabetes to Spinal Stenosis
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Secondary#lumbarspinalstenosis#diabetes#poorglycemiccontrol#prediabetes
To what extent is diabetes a risk factor for lumbar spinal stenosis? An international team of researchers designed a massive study to quantify the connection between diabetes and lumbar spinal stenosis. Their work, “Diabetes Mellitus and Poor Glycemic Control Are Associated With a Higher Risk of Lumbar Spinal Stenosis: An Analysis of a Large Nationwide Database,” was published in the May 1, 2024 edition of Spine.
Co-author Assaf Kadar, M.D. an orthopedic surgeon at the Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel, told OTW, “Dr. Shai Shemesh, who is the lead author, postulated that the ligamentum flavum, the culprit of spinal stenosis, is in fact an overlooked ‘target organ’ for diabetes. The effect of diabetes on other target organs (nerves, retina, kidney and more) have been extensively studied, but there is scarce literature about spinal stenosis.”
In total, 49,576 patients diagnosed with lumbar spinal stenosis were matched with controls of the same number based on age and sex. The researchers found a higher likelihood of lumbar spinal stenosis in diabetic patients; those with hemoglobin A1c ≥7% and ≥1 diabetes-related complication also had an elevated likelihood of having this diagnosis. The team determined that prolonged diabetes exposure increased the risk.
Having a diabetes diagnosis reduced median survival by around 4.5 years for both stenotic and non-stenotic patients; spinal stenosis diagnosis alone minimally impacted survival. A multivariate analysis revealed a significantly increased risk of all-cause mortality in patients with diabetes and lumbar spinal stenosis and those with diabetes without stenosis compared with controls.
Dr. Kadar, also affiliated with the Roth|McFarlane Hand & Upper Limb Centre, St. Joseph’s Hospital and Western University in Canada, explained to OTW, “This work established the causal relationship of poor glycemic control and long-standing diabetes to high risk of spinal stenosis. In essence, this finding confirms the hypothesis that glycosylation (the effect of high glucose levels on tissues) effects the ligamentum flavum in a dose dependent manner.”
“The study will help surgeons and physicians educate their patients on the deleterious effect of poor diabetes control on spinal stenosis. All physicians like to quote that ‘Prevention is better than cure.’ We feel that with our findings, clinicians have a powerful prevention tool that can be specifically applied to diabetic patients with early spinal stenosis.”
Going forward, Dr. Kadar told OTW, “We need to have basic science studies defining the mechanism of the effect of high glucose levels on the ligamentum flavum. In addition, we need large-scale prospective clinical trials looking at the various diabetes treatment options and its effect on spinal stenosis.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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