Electrophysiological evidence of diabetes’ impacts on central conduction recoveries in degenerative cervical myelopathy after surgery

• Published in: European spine journal Vol. 32; no. 6; pp. 2101 - 2109
• Main Authors: Yu, Zhengran, Chen, Chong, Yu, Tao, Ye, Yongyu, Zheng, Xiaoqing, Zhan, Shiqiang, Zeng, Shixing, Zou, Xuenong, Chang, Yunbing
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2023; Springer Nature B.V
• Subjects: Central nervous system diseases; Cervical Vertebrae - surgery; Conduction; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus - epidemiology; Humans; Insulin; Insulins; Medicine; Medicine & Public Health; Motor evoked potentials; Neurosurgery; Original Article; Pyramidal tracts; Regeneration; Risk factors; Somatosensory evoked potentials; Spinal cord; Spinal Cord Diseases - surgery; Surgery; Surgical Orthopedics; Treatment Outcome; Degenerative cervical myelopathy; Motor evoked potentials; Somatosensory evoked potentials; Central conduction time; Diabetes mellitus
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-023-07605-8

Objectives To assess the impact of diabetes mellitus (DM) on the postoperative motor and somatosensory functional recoveries of degenerative cervical myelopathy (DCM) patients. Methods Motor and somatosensory evoked potentials (MEP and SSEPs) and modified Japanese Orthopedic Association (mJOA) scores were recorded in 27 diabetic (DCM-DM group) and 38 non-diabetic DCM patients (DCM group) before and 1 year after surgery. The central motor (CMCT) and somatosensory (CSCT) conduction time were recorded to evaluate the conductive functions of the spinal cord. Results The mJOA scores, CMCT and CSCT improved ( t test, p  < 0.05) in both of the DCM-DM and DCM groups 1 year after surgery. The mJOA recovery rate (RR) and CSCT recovery ratio were significantly worse ( t test, p  < 0.05) in the DCM-DM group compared to the DCM group. DM proved to be a significant independent risk factor for poor CSCT recovery (OR = 4.52, 95% CI 2.32–7.12) after adjusting for possible confounding factors. In DCM-DM group, CSCT recovery ratio was also correlated with preoperative HbA1 level ( R  =  − 0.55, p  = 0.003). Furthermore, DM duration longer than 10 years and insulin dependence were risk factors for lower mJOA, CMCT and CSCT recoveries among all DCM-DM patients ( t test, p  < 0.05). Conclusions DM may directly hinders spinal cord conduction recovery in DCM patients after surgery. Corticospinal tract impairments are similar between DCM and DCM-DM patients, but significantly worsened in chronic or insulin-dependent DM patients. The dorsal column is more sensitively affected in all DCM-DM patients. Deeper investigation into the mechanisms and neural regeneration strategies is needed.