Hyperglycemia and its influence on development of lumbar degenerative disc disease

STUDY DESIGN: A Retrospective observational study. OBJECTIVES: To determine the influence of hyperglycemia on severity of lumbar degenerative disc disease (LDDD). METHODS: We retrospectively included 199 patients with low back pain (LBP) who visited our tertiary care hospital from June 2016 to December 2018. All patients divided into three groups as per inclusion and exclusion criteria. Group-A had patients without DM (n = 75). Group B had well-controlled DM patients (n = 72) and Group-C had uncontrolled DM patients (n = 52). Group B and C subdivided according to dutation of DM. Group-B1 DM duration was ≤ 10 years (n = 38), Group-B2 DM duration was >10 years (n = 34), Group-C1 DM duration ≤10 years (n = 28), Group-C2 DM duration >10 years (n = 24). Sex, age, BMI, occupation, smoking history, alcohol use and duration of type-II DM were recorded. The severity of LDDD was evaluated using the five-level Pfirrmann grading system. Operated patient's disc material sent for histological examination. RESULTS: Patients with DM showed more severe disc degeneration compared to patients without DM. The average Pfirrmann scores between Groups A and B1 had no difference; Groups B2, C1, and C2 showed higher average Pfirrmann-scores than Group-A (p > 0.05). Group-B2 and Group-C2 showed higher average Pfirrmann-scores than Group-B1 and Group-C1 (p > 0.05). Group-C1 and Group-C2 showed higher average Pfirrmann-scores than Group-B1 and B2 (p > 0.05). The severity of LDDD was significantly related to DM duration both in groups B & C (p > 0.05). DM groups showed increased disc apoptosis and matrix aggrecan fragmentation, Disc glycosaminoglycan content and histological significantly different, the results are similar to Pfirrmann-score results. CONCLUSIONS: There is a positive relationship between diabetes and LDDD. A longer the duration and poor control of hyperglycemia could aggravate disc degeneration.