Perioperative Complications of Lumbar Instrumentation and Fusion in Patients with Diabetes Mellitus

Steven D. Glassman, MD, Gary Alegre, MD, Leah Carreon, MD, John R. Dimar, MD, John R. Johnson, MD

To clarify the perioperative risk for patients with diabetes mellitus undergoing instrumented lumbar fusion as compared with controls. To identify differences, if any exist, between patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes (NIDDM).

There was a significant difference in complication rate between the NIDDM (53%) and IDDM (56%) groups versus controls (21%). There was a significant increase in complications with multilevel fusion in all groups and with increased operative time in the IDDM group. There was a significantly greater nonunion rate in the NIDDM (22%) and IDDM (26%) groups as compared with controls (5%).

Patients with both IDDM and NIDDM have a significantly increased risk of perioperative complications as compared with controls when treated by lumbar instrumentation and fusion.

Even in appropriately selected diabetic patients, less satisfactory outcomes after decompression have been reported as compared with nondiabetic controls. These diminished results have been attributed to coexisting diabetic neuropathy or concomitant small vessel disease that impairs neural recovery.

In contrast, results of the present study suggest a significantly higher perioperative morbidity for patients with diabetes undergoing instrumentation and fusion procedures. We observed a total complication rate of 53% in patients with NIDDM and 56% in patients with IDDM, as compared to a 21% complication rate in matched controls. The increase in complication rate for both diabetic groups was statistically significant at the p=.001 level.

The findings of this study validate the clinical perception of an increased complication rate in diabetics treated by lumbar instrumentation and fusion. The study also demonstrates an increased risk associated with longer operative time and multilevel fusions.

On the basis of these data, it seems prudent to warn diabetic patients of the potential increased risk of perioperative complications associated with lumbar instrumentation and fusion procedures. Diabetics have a higher incidence of nonunion.