Effect of type 2 diabetes mellitus on patients undergoing percutaneous endoscopic lumbar discectomy: a retrospective propensity score-matched cohort study

Objective The effect of Type 2 diabetes mellitus (T2DM) on lumbar disc herniation (LDH) remains controversial. This retrospective cohort study aims to investigate the effect of T2DM on the LDH patients underwent percutaneous endoscopic lumbar discectomy (PELD) throughout pre, peri and post operation. Methods : This study included patients underwent PELD surgery from October 2021 to January 2024. General data including age, gender and body mass index (BMI), hemoglobin, hypertension and coronary heart disease (CHD) were collected. Clinical data including Visual Analogue Scale (VAS) score, surgical time, blood loss, length of hospital stay, recurrence ratio and reoperation ratio were recorded. Imaging data include L1-5 cobb angle, lumbar range of motion (ROM), relative cross-sectional area (CSA) and fat infiltration ratio (FIR) of the paraspinal muscles, abdominal aorta calcification (AAC), disc Pfirrmann grading, herniated disc Michigan State University (MSU) classification and Lee Zoning et al. were measured. Propensity score-matched (PSM) analysis with 1:1 ratio was performed to eliminate the influence of confounding factors using a multi-variable logistic regression model before analysis. Results 728 patients were eligible in this study, and significant difference was detected in age, hypertension and CHD between the T2DM group and Control group. After PSM analysis and matching, 56 pairs of patients generated and were included for further analysis. The patients in the T2DM possessed significantly higher grades of Pfirrmann score and AAC ratio (48.21% vs. 25.00%) than control group. Postoperative VAS of the T2DM group was 2(IQR = 1), which was significantly higher than the Control group, which was 1(IQR = 2). The recurrence and reoperation ratio were 21.43% and 16.07% respectively in the T2DM group, both of which were notably higher than the Control group (5.36% and 1.79%). Conclusion T2DM may aggravate disc degeneration, impede postoperative symptom relief, and increase recurrence and reoperation rates after PELD.