Abstract
BACKGROUND: In patients with cervical spondylotic myelopathy (CSM), the presence of a high spinal cord signal (HCS) on T2-weighted magnetic resonance imaging (MRI) is a critical diagnostic marker. Diabetes mellitus (DM), a common chronic disease, critically impacts neurologic recovery and postoperative HCS resolution. However, literature exploring the interplay between DM and postoperative HCS changes in CSM patients remains sparse. This study aims to elucidate the association between preoperative levels of glycated hemoglobin (HbA1c) and the extent of postoperative HCS improvement in this patient cohort. By focusing on this intersection, the research intends to provide deeper insights into personalized treatment strategies for optimizing neurological recovery in CSM patients with concomitant diabetes. METHODS: In this study, we conducted a comprehensive review of medical records from a cohort of cervical spondylotic myelopathy (CSM) patients with diabetes mellitus. We collected demographic data, including age, gender, smoking status, presence of hypertension, and body mass index (BMI). Neurological status was quantitatively assessed both preoperatively and postoperatively using the Japanese Orthopaedic Association (JOA) scoring system. Furthermore, we systematically evaluated preoperative and postoperative T2-weighted magnetic resonance imaging (MRI) to monitor changes in the high spinal cord signal (HCS). The primary objective was to determine the statistical correlation between preoperative levels of glycated hemoglobin (HbA1c) and postoperative improvements in HCS among these patients. By analyzing these variables, the study aims to elucidate the impact of glycemic control on neurological recovery in a well-defined diabetic CSM patient population. RESULTS: The findings from this investigation underscore the critical role of preoperative glycated hemoglobin (HbA1c) levels in determining the postoperative outcomes in patients with cervical spondylotic myelopathy (CSM) who also have diabetes mellitus. Our analysis reveals that although preoperative HbA1c levels did not significantly impact outcomes at six months post-surgery (Table2 and Table4), maintaining low HbA1c levels was associated with considerable improvements in both spinal cord high signal (HCS) and neurological function at two years postoperatively (Table3 and Table5). At the same time, we demonstrated that keeping the preoperative HbA1c level within 6.8% was more favourable to the improvement of HCS in patients at 2 years after surgery (Table6 and Table7). CONCLUSIONS: In patients with cervical spondylotic myelopathy (CSM) comorbid with diabetes mellitus, our study has quantitatively established a significant correlation between preoperative glycosylated hemoglobin (HbA1c) levels and postoperative neurological outcomes. We demonstrated that maintaining a low preoperative HbA1c level, as low as possible within 6.8%, is critical for improving high signal change (HCS) in the spinal cord and enhancing long-term neurological recovery. These findings emphasize the importance of stringent glycemic control before surgery to optimize postoperative neurological prognosis in CSM patients with diabetes. By providing concrete evidence of the benefits of preoperative glycemic management, this research offers new, evidence-based guidelines for clinical perioperative care, potentially improving patient outcomes and guiding future therapeutic strategies.