The impact of type 2 diabetes on bone metabolism and growth after spinal fusion.

Autor: Bhamb N; Orthopaedic Department, Cedars-Sinai, 444 S San Vicente Blvd., Los Angeles, CA, USA., Kanim LEA; Orthopedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., A8308 Los Angeles, CA, USA., Maldonado RC; Orthopaedic Department, Cedars-Sinai, 444 S San Vicente Blvd., Los Angeles, CA, USA; Cedars-Sinai Orthopaedic Biomechanics Laboratory, 8700 Beverly Blvd., Davis Building 6006 Los Angeles, CA, USA., Nelson TJ; Orthopaedic Department, Cedars-Sinai, 444 S San Vicente Blvd., Los Angeles, CA, USA; Cedars-Sinai Orthopaedic Biomechanics Laboratory, 8700 Beverly Blvd., Davis Building 6006 Los Angeles, CA, USA., Salehi K; Orthopaedic Department, Cedars-Sinai, 444 S San Vicente Blvd., Los Angeles, CA, USA; Orthopedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., A8308 Los Angeles, CA, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. Advanced Health Sciences Pavilion, Los Angeles, CA, USA., Glaeser JD; Orthopaedic Department, Cedars-Sinai, 444 S San Vicente Blvd., Los Angeles, CA, USA; Orthopedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., A8308 Los Angeles, CA, USA; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. Advanced Health Sciences Pavilion, Los Angeles, CA, USA., Metzger MF; Orthopaedic Department, Cedars-Sinai, 444 S San Vicente Blvd., Los Angeles, CA, USA; Cedars-Sinai Orthopaedic Biomechanics Laboratory, 8700 Beverly Blvd., Davis Building 6006 Los Angeles, CA, USA. Electronic address: Melodie.Metzger@cshs.org.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2019 Jun; Vol. 19 (6), pp. 1085-1093. Date of Electronic Publication: 2018 Dec 07.
DOI: 10.1016/j.spinee.2018.12.003
Abstrakt: Background Context: Some clinical reports suggest diabetes may have a negative effect on spinal fusion outcomes, although no conclusive experimental research has been conducted to investigate the causality, impact, and inherent risks of this growing patient population.
Purpose: To analyze the hypothesis that type 2 diabetes (T2DM) inhibits the formation of a solid bony union after spinal fusion surgery by altering the local microenvironment at the fusion site through a reduction in growth factors critical for bone formation.
Study Design/setting: In vivo rodent model of type 2 diabetes.
Methods: Twenty control (Sprague Dawley, SD) and 30 diabetic (Zucker Diabetic Sprague Dawley, ZDSD) rats underwent posterolateral and laminar fusion surgery using a tailbone autograft implanted onto the L4/L5 transverse processes. A subset of animals was sacrificed 1-week postsurgery for growth factor analysis. Remaining rats were sacrificed 3-month postsurgery for fusion evaluation via manual palpation, micro-CT, and histology.
Results: There was no significant difference in the manual palpation fusion rate between ZDSD rats and SD control rats. Growth factor assay of fusion site explants at early sacrifice demonstrated PDGF was upregulated in the ZDSD rats. TGFB, IGF, and VEGF were not statistically different between groups. Bone mineral density as determined by micro-CT was significantly lower in ZDSD rats compared to SD controls and was a significant function of HbA1c.
Conclusions: Data generated in this in vivo rat model of T2DM demonstrate that the metabolic dysregulation associated with the diabetic condition negatively impacts the quality and density of the formed fusion mass. Increased measures of diabetic status, as determined by blood glucose and HbA1c, were correlated with decreased quality of formed fusion, highlighting the importance of diabetic status monitoring and regulation to bone health, particularly during bone healing.
Clinical Relevance: T2DM rats demonstrated increased rates of infection, metabolic dysregulation, and a reduction in spinal fusion consolidation. Clinicians should consider these negative effects during preoperative care and treatment of this growing patient population.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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