The Impact of Diabetes Mellitus on Patient-Reported Outcomes of Chronic Low Back Pain with Modic Changes at One Year: A Prospective Cohort Study

Abstract

Study Design Prospective cohort study. Objectives Diabetes mellitus (DM) is associated with unfavourable patient-reported outcomes after spine surgery. Chronic low back pain (CLBP) with Modic Changes (MCs) in the lumbar vertebrae, as observed on MRI, forms a specific subgroup. This study aims to investigate the potential influence of DM on CLBP with MCs. Methods This study involved 259 patients with CLBP accompanied MCs. We recorded the patient-reported outcomes (visual analogue scale (VAS), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ)) at baseline, 3, 6, and 12 months. Multivariable linear regression analyses were performed to determine predictors of patient-reported outcomes. Results 103 patients had DM. Patients with DM exhibited higher VAS ( P < .05), ODI ( P < .001), and RMDQ ( P < .001) scores at 3, 6, and 12 months, while patients without DM experienced more significant improvements in the scores over time ( P < .001). Patients with DM reported longer durations of physical exercise ( P = .007). Additionally, patients without DM had a significantly higher patient satisfaction index ( P < .001) and a lower prevalence of hypertension ( P < .001). Notably, significant differences were observed in the distribution of MCs of lumbar vertebrae ( P = .034) and Pfirrmann grades of intervertebral disc degeneration between two groups ( P < .001). Conclusion Patients with DM demonstrated poorer patient-reported outcomes compared to those without DM in 1-year. DM emerged as an independent predictor of adverse patient-reported outcomes. It can be utilized to enhance the management and treatment of CLBP in patients with MCs.