Diabetes Mellitus and Poor Glycemic Control are Associated with a Higher Risk of Lumbar Spinal Stenosis

Abstract

Study Design. A large-scale retrospective case-control study. Objective. Examine diabetes as a risk factor for lumbar spinal stenosis development and evaluate the impact of diabetes duration, glycemic control, and associated complications on this risk. Summary of Background Data. Diabetes mellitus, a multiorgan disorder impacting various connective tissues, induces histological changes in spinal structures, particularly the ligamentum flavum. While clinical studies suggest a higher incidence of lumbar spinal stenosis in diabetic patients, substantial epidemiological research on the likelihood of lumbar spinal stenosis diagnosis in individuals with diabetes is scarce. Materials and Methods. Using nationwide data, a total of 49,576 patients diagnosed with lumbar spinal stenosis based on ICD-10 codes were matched with controls of the same number based on age and sex. Employing a multivariable logistic regression model, the study assessed for the association between spinal stenosis and diabetes, while adjusting for confounders. Results. We found a higher likelihood of lumbar spinal stenosis diagnosis in diabetic patients (OR 1.39, 95% CI 1.36 – 1.43, P<0.001). Those with HbA1c ≥7% and ≥1 diabetes-related complication also had an elevated likelihood (OR 1.19, 95% CI 1.08 – 1.31, P=0.001). Prolonged diabetes exposure increased the risk. Diabetes diagnosis reduced median survival by around 4.5 years for both stenosis and non-stenosis patients; spinal stenosis diagnosis alone minimally impacted survival. Relative to individuals diagnosed with diabetes mellitus (DM) at the age of 65 or older, the odds ratio (OR) for developing lumbar spinal stenosis (LSS) were 1.22 (95% CI 1.18 – 1.27, P<0.001) when DM was diagnosed at 50-65 years old and 1.67 (95% CI 1.56 – 1.79, P<0.001) for those under 50 years old. Multivariate analysis revealed a significantly increased risk of all-cause mortality in patients with DM and spinal stenosis (HR 1.36, 95% CI 1.29 – 1.44, P<0.001) and those with DM without stenosis (HR 1.49, 95% CI 1.41 – 1.57, P<0.001), compared to controls. Conclusion. Diabetic patients with prolonged disease, poor glycemic control, and diabetes-related complications face an elevated risk of developing lumbar spinal stenosis. Recognizing the reciprocal adverse relationship between these conditions is crucial in clinical practice and designing public health measures for managing both conditions. Level of Evidence. 4