{"paper_id":"f6e4f5de-bc35-480b-8cfc-80ad8f66d930","body_text":"Abstract\nPurpose\nThis study aimed to elucidate the association between comorbid hypertension (HT) and diabetes mellitus (DM) (HT in DM) and clinical outcomes after cervical laminoplasty.\nMethods\nThis retrospective multi-institutional study enrolled patients who underwent laminoplasty between 2008 and 2017. The primary outcome was the recovery rate of JOA score. The secondary outcome was in-hospital all-cause postoperative complications.\nResults\nThis study included 1002 patients (mean age, 66 years; 30% women) who were divided into 4 groups based on the presence of medically-treated HT and/or DM. The overall incidence of DM was 17%, and the prevalence of HT was 47% in diabetic patients. Patients with HT in DM showed similar preoperative JOA scores compared to those without both HT and DM. However, patients with HT in DM showed poorer postoperative JOA scores and worse JOA-RR (non-HT/DM, 48%; DM, 43%; HT, 37%; HT in DM, 28%; p < 0.05). Patients with HT in DM tended to have a higher risk of postoperative complications (2.5%, 5.4%, 3.0%, and 7.4%; p = 0.09), especially C5 palsy (0.8%, 3.0%, 1.7%, and 4.9%; p = 0.04). After adjusting confounders, the presence of HT in DM was an independent risk factor for failure to achieve the JOA-RR MCID (JOA-RR < 42%) (OR = 3.6).\nConclusions\nApproximately half of patients with DM had HT. HT in DM was closely associated with unfavorable surgical outcomes, including an increased incidence of in-hospital postoperative complications and an elevated risk of C5 palsy. In contrast, patients with DM alone demonstrated relatively favorable outcomes.\nSimilar content being viewed by others\nReferences\nKimura A, Takeshita T, Yoshii K et al (2021) Impact of diabetes Mellitus on cervical spine surgery for ossification of the posterior longitudinal ligament. J Clin Med 10(15):3375. https://doi.org/10.3390/jcm10153375. Published 2021 Jul 29\nRodrigues-Pinto R, Montenegro TS, Davies BM et al (2022) Optimizing the application of surgery for degenerative cervical myelopathy [AO Spine RECODE-DCM Research Priority Number 10]. Global Spine J 12(1suppl):147S–158S. https://doi.org/10.1177/21925682211062494\nNagoshi N, Watanabe K, Nakamura M et al (2023) Does Diabetes affect the Surgical outcomes in cases with cervical ossification of the posterior longitudinal ligament? A Multicenter Study from Asia Pacific Spine Study Group. Global Spine J 13(2):353–359. https://doi.org/10.1177/2192568221996300\nPartha Sarathi CI, Sinha A, Rafati Fard A et al (2024) The significance of metabolic disease in degenerative cervical myelopathy: a systematic review. Front Neurol 15:1301003 Published 2024 Feb 5. https://doi.org/10.3389/fneur.2024.1301003\nLiu Y, Ban DX, Kan SL, Cao TW, Feng SQ (2017) The impact of diabetes Mellitus on patients undergoing cervical spondylotic myelopathy: a Meta-analysis. Eur Neurol 77(1–2):105–112. https://doi.org/10.1159/000453547\nKalb S, Zaidi HA, Ribas-Nijkerk JC et al (2015) Persistent outpatient hypertension is independently Associated with spinal cord dysfunction and imaging characteristics of spinal cord damage among patients with cervical spondylosis. World Neurosurg 84(2):351–357. https://doi.org/10.1016/j.wneu.2015.03.030\nNagata K, Miyahara J, Nakamoto H et al (2022) Effect of diabetes on patient-reported outcome measures at one year after laminoplasty for cervical spondylotic myelopathy. Sci Rep 12(1):9684 Published 2022 Jun 11. https://doi.org/10.1038/s41598-022-13838-2\nTakasawa E, Sorimachi Y, Iizuka Y et al (2019) Risk factors for Rapidly Progressive Neurological Deterioration in Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 44(12):E723–E730. https://doi.org/10.1097/BRS.0000000000002969\nPerdomo-Pantoja A, Chara A, Kalb S et al (2020) The effect of renin-angiotensin system blockers on spinal cord dysfunction and imaging features of spinal cord compression in patients with symptomatic cervical spondylosis. Spine J 20(4):519–529. https://doi.org/10.1016/j.spinee.2019.12.002\nChiang TY, Wang YK, Huang WC, Huang SS, Chu YC (2022) Intraoperative hypotension in non-emergency decompression surgery for cervical spondylosis: The role of chronic arterial hypertension. Front Med (Lausanne). 9:943596. Published 2022 Oct 18. https://doi.org/10.3389/fmed.2022.943596\nDavies BM, Mowforth O, Gharooni AA et al (2022) A New Framework for investigating the Biological basis of degenerative cervical myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: mechanical stress, vulnerability and time. Global Spine J 12(1suppl):78S–96S. https://doi.org/10.1177/21925682211057546\nHu FB, Stampfer MJ (2005) Insulin resistance and hypertension: the chicken-egg question revisited. Circulation 112(12):1678–1680. https://doi.org/10.1161/CIRCULATIONAHA.105.568055\nCheung BM, Li C (2012) Diabetes and hypertension: is there a common metabolic pathway? Curr Atheroscler Rep 14(2):160–166. https://doi.org/10.1007/s11883-012-0227-2\nWei GS, Coady SA, Goff DC Jr et al (2011) Blood pressure and the risk of developing diabetes in African americans and whites: ARIC, CARDIA, and the framingham heart study. Diabetes Care 34(4):873–879. https://doi.org/10.2337/dc10-1786\nJia G, Sowers JR (2021) Hypertension in diabetes: an update of Basic mechanisms and Clinical Disease. Hypertension 78(5):1197–1205. https://doi.org/10.1161/HYPERTENSIONAHA.121.17981\nOshima Y, Takeshita K, Kato S et al (2022) Comparison between the Japanese Orthopaedic Association (JOA) score and patient-reported JOA (PRO-JOA) score to Evaluate Surgical outcomes of degenerative cervical myelopathy. Global Spine J 12(5):795–800. https://doi.org/10.1177/2192568220964167\nKanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl 48(3):452–458. https://doi.org/10.1038/bmt.2012.244\nMagliano DJ, Boyko EJ, IDF Diabetes Atlas (2021) 10th edition scientific committee. IDF DIABETES ATLAS. 10th ed. Brussels: International Diabetes Federation\nGBD 2021 Diabetes Collaborators (2023) Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of Disease Study 2021 [published correction appears in Lancet. 2023;402(10408):1132. Doi: 10.1016/S0140-6736(23)02044-5]. Lancet 402(10397):203–234. https://doi.org/10.1016/S0140-6736(23)01301-6\nJiang S, Yu T, Di D, Wang Y, Li W (2024) Worldwide burden and trends of diabetes among people aged 70 years and older, 1990–2019: a systematic analysis for the global burden of Disease Study 2019. Diabetes Metab Res Rev 40(3):e3745. https://doi.org/10.1002/dmrr.3745\nTu J, Vargas Castillo J, Das A, Diwan AD (2021) Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms. J Clin Med.;10(6):1214. Published 2021 Mar 15. https://doi.org/10.3390/jcm10061214\nWang M, Liu Y, Liang Y, Naruse K, Takahashi K (2021) Systematic understanding of pathophysiological mechanisms of oxidative stress-related conditions-diabetes Mellitus, Cardiovascular diseases, and Ischemia-Reperfusion Injury. Front Cardiovasc Med 8:649785 Published 2021 Apr 13. https://doi.org/10.3389/fcvm.2021.649785\nAmerican Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2020 [published correction appears in Diabetes Care (2020);43(8):1977–1978. doi: 10.2337/dc20-ad08]. Diabetes Care. 2020;43(Suppl 1):S111-S134. https://doi.org/10.2337/dc20-S010\nWhelton PK, Carey RM, Aronow WS et al (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines [published correction appears in hypertension. 2018;71(6):e140-e144. Doi: 10.1161/HYP.0000000000000076]. Hypertension 71(6):e13–e115. https://doi.org/10.1161/HYP.0000000000000065\nLeung AA, Daskalopoulou SS, Dasgupta K et al (2017) Hypertension Canada’s 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults [published correction appears in Can J Cardiol. 33(12):1733–1734. https://doi.org/10.1016/j.cjca.2017.09.006]. Can J Cardiol. 2017;33(5):557–576. https://doi.org/10.1016/j.cjca.2017.03.005\nUmemura S, Arima H, Arima S et al (2019) The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res 42(9):1235–1481. https://doi.org/10.1038/s41440-019-0284-9\nGupta R, Chanbour H, Roth SG et al (2023) The Ideal threshold of Hemoglobin A1C in Diabetic patients undergoing elective lumbar decompression surgery. Clin Spine Surg 36(6):E226–E233. https://doi.org/10.1097/BSD.0000000000001399\nRoth SG, Chanbour H, Gupta R et al (2022) Optimal hemoglobin A1C target in diabetics undergoing elective cervical spine surgery [published correction appears in Spine J.;22(9):1589–1592. https://doi.org/10.1016/j.spinee.2022.05.005]. Spine J. 2022;22(7):1149–1159. https://doi.org/10.1016/j.spinee.2022.02.014\nTelemi E, Mansour TR, Brennan M et al (2024) Does Tighter Glycemic Control Beyond Hemoglobin A1c of 8% Improve Outcome for Lumbar Spine Surgery? A MSSIC Study. Neurosurgery. Published online January 19. https://doi.org/10.1227/neu.0000000000002838\nAcknowledgements\nN/A.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthical approval\nThe research protocol was approved by our institutional review board (approval number: HS2019−117), and informed consent was obtained from all of the patients.\nPermission to reproduce copyrighted materials or signed patient consent forms\nN/A.\nConflict of interest\nThe authors declare no conflicts of interest in association with the present study.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nTomomatsu, Y., Takasawa, E., Iizuka, Y. et al. Impact of hypertension in diabetes on surgical outcomes after cervical laminoplasty - a retrospective, multi-institutional study of 1002 patients. Eur Spine J 34, 1301–1308 (2025). https://doi.org/10.1007/s00586-025-08673-8\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00586-025-08673-8","source_license":"CC0","license_restricted":false}