Laminoplasty for Degenerative Cervical Myelopathy in Patients with Diabetes: A Systematic Review and Meta-analysis

Introduction: Diabetes mellitus is a common comorbidity in patients undergoing surgery for degenerative cervical myelopathy (DCM). Existing studies report inconsistent results regarding diabetes’ impact on outcomes of posterior decompression surgery for DCM. This systematic review and meta-analysis aimed to determine the effects of diabetes on pre- and post-operative neurological outcomes, recovery rates, and complication rates in laminoplasty for DCM.

Methods: We searched PubMed, Embase, and Cochrane for observational studies and randomized controlled trials examining diabetes’ impact on surgical outcomes for laminoplasty in DCM patients. Primary outcomes included pre- and post-operative Japanese Orthopaedic Association (JOA) scores, recovery rate (RR) of JOA, and complication rates. Statistical analyses calculated standard mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI).

Results: Eight studies with 1,388 patients (mean age 66.4 years; 36% female) were included. Diabetic patients had significantly lower pre-operative JOA scores than non-diabetics (SMD = -0.30; 95% CI: -0.46 to -0.14; p < 0.001). Post-operative JOA scores remained lower for diabetics (SMD = -0.30; 95% CI: -0.46 to -0.14; p < 0.001), but recovery rates of JOA were similar between groups (SMD = -0.25; 95% CI: -0.62 to 0.12; p = 0.181). Diabetic patients were less likely to achieve a recovery rate ≥50% (OR = 0.44; 95% CI: 0.27 to 0.72; p < 0.001) and more likely to achieve < 50% recovery (OR = 2.26; 95% CI: 1.39 to 3.69; p = 0.001). Complication rates were similar between groups (OR = 1.82; 95% CI: 0.78 to 4.25; p = 0.169).

Conclusion : Laminoplasty is a viable surgical option for DCM in diabetic patients, with comparable neurological recovery and complication risks to non-diabetics despite lower baseline and post-operative JOA scores.