The Clinical Characteristics, Perioperative Management, and Treatment Outcomes of Spinal Tuberculosis Associated With Diabetes Mellitus
Authors: Zhang Hongqi , Xiao Lige , Tang Mingxing , Sun Yang , Yang Guanteng 
Published: August 2021

Abstract
Background. Diabetes mellitus (DM) is a chronic systemic disorder that mainly damages small blood vessels and nerves. Previous studies indicate that DM is a major risk factor for perioperative complications of spine surgeries, such as wound infection, prolonged operative time, longer hospitalization, and higher nonunion rates. However, to the best of our knowledge, no study has compared differences between spinal tuberculosis associated with diabetes mellitus (DMSTB) and non-DMSTB in terms of clinical characteristics, perioperative management, radiographic outcomes and surgical complications.Methods. We performed a retrospective study of 11 DMSTB patients who underwent surgical treatment between January 2014 and April 2018. We also reviewed 11 matching non-DMSTB patients. Matching characteristics included age, sex, and the range of bone destruction by spine tuberculosis. All patients underwent the same surgical procedure. For each patient, demographic information, including age, sex, residence, chief complaints, preoperative complications, the length of stay (LOS), and hospitalization expenses (USD), was reviewed. In addition, operation time, intraoperative blood loss, and postoperative complications were reviewed from digital medical records. Moreover, laboratory examination and radiographic assessments were conducted before operation and at 3-month follow-up/final follow-up (FFU).Results. A total of 22 patients were divided into two groups: Group A (DMSTB) and Group B (non-DMSTB). All patients in Group A were newly diagnosed with spinal tuberculosis, while 4 were newly diagnosed with DM. The remaining 7 patients had been diagnosed with DM for an average of 6.15 ±5.87 yrs. The lumbar and lumbosacral regions were the most affected regions for 6 patients. Significant differences in residence (p=0.02) and preoperative complications (p=0.002) were found between Groups A and B. There were no differences in operation times (292.72±56.74 vs. 281.81±46.28 min, p=0.64), intraoperative blood loss levels (627.27±486.34 vs. 668.18±350.50 ml, p=0.83), hospitalization expenses ($19713.13±5816.89 vs. $16509.78±3170.89, p=0.14), or LOS periods (25.54±4.65 vs. 27.63±10.79 days, p=0.58). There were no significant differences in erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) between Groups A and B at each time point: preoperation and at 3-month follow-up/FFU. The albumin level was lower than that in the normal stand in both groups preoperatively (35.82±4.22 vs. 37.7±2.57g/L, p=0.24) and returned to normal at FFU (42.67±2.91 vs. 43.26±2.48 g/L, p=0.63). The imaging analysis shows no significant differences in vertebral body destruction between Group A and Group B (1.45±0.75 vs. 1.31±0.71, p=0.68) with a similar fusion level (2.63±1.43 vs. 2.81±1.74, p=0.8). The bone fusion times for Groups A and B were measured as 10.27±3.01 months and 9.9±2.11 months, respectively (p=0.87). There were no significant differences in postoperative complications between the DMSTB and non-DMSTB groups (p=0.42).Conclusion. Our study demonstrates that DMSTB has a higher incidence of preoperative complications than non-DMSTB, which increases the difficulty of perioperative management for spinal tuberculosis. However, DMSTB does not significantly affect postoperative recovery as long as the glycemic level remains well controlled, nutritional supplementation is adequate, and antituberculosis treatment is sufficient.