MethodsA total of 286 patients with lumbar degenerative diseases who were diagnosed and treated in the Department of Spinal Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2021 to December 2022 were retrospectively collected. Patients were divided into diabetic and non-diabetic groups according to whether T2DM was diagnosed at admission. Age, gender, presence of hypertension, and body mass index (BMI) were recorded. The duration of diabetes was recorded. Fasting blood glucose and peak postprandial blood glucose were monitored for 3 consecutive days. Plasma glucose and glycosylated hemoglobin were assessed by blood biochemical results. Diabetic patients were divided into three sub-groups according to fasting blood glucose and glycosylated hemoglobin levels (HbA1c): ideal blood glucose control (HbA1c<6.5% and fasting blood glucose<6.1 mmol/L), good (6.5%≤HbA1c≤7.5% or 6.1 mmol/L≤fasting blood glucose≤7.0 mmol/L), and poor (HbA1c>7.5% and fasting blood glucose>7.0 mmol/L). Visual analogue scale (VAS) was used to assess the degree of low back pain. Pathria grading system was used to assess the severity of FJOA at different levels of the lumbar spine on lumbar CT. Mann-whitney U test was used to compare the difference of FJOA between L1-S1 segments in diabetic and non-diabetic patients. Logistic regression was used to analyze the effect of diabetes on FJOA. Kruskal-Wallis test was used to compare the difference of FJOA between different segments in diabetic patients among different sub-groups. Logistic regression was used to analyze the effect of blood glucose control on FJOA.
ResultsA total of 121 patients in the diabetic group and 165 patients in the non-diabetic group were included. L4, 5 FJOA grade 3(2, 3) in diabetic patients was greater than grade 2(1, 3) in non-diabetic patients with significant difference (Z=-3.179, P=0.001), and diabetes was an independent risk factor for L4, 5 FJOA [OR=1.767, 95%CI(1.032, 3.025), P=0.038]. There was no significant difference in age, BMI, sex ratio, prevalence of hypertension and blood glucose fluctuation values among different subgroups of glycemic control in the diabetic group. Patients in the poor glucose group had higher FJOA grades 2(1, 2), 3(3, 3) and 3(2, 4) at L1, 2, L4, 5 and L5S1 than those in the ideal glucose group at grades 1(1, 2), 2(1.5, 3) and 2(1, 2) with significant differences (H=9.530, P=0.009; H=18.248, P<0.001; H=27.916, P<0.001). Patients in the poor glucose group had higher grades 3(3, 3) and 3(2, 4) of osteoarthritis of the L4, 5 and L5S1 facet joints than those in the good glucose group, grades 3(2, 3) and 2(1, 2) with significant differences (H=18.248, P<0.001; H=27.916, P<0.001). Low back pain was positively correlated with poor glycemic control, L4, 5 and L5S1 FJOA (r=0.512, P<0.001; r=0.383, P<0.001; r=0.484, P<0.001). Poor glycemic control was an independent risk factor for FJOA at L4, 5 and L5S1 [OR=4.963, 95%CI (1.095, 22.496), P=0.038; OR=6.010, 95%CI(1.061, 34.049), P=0.043].
ConclusionCompared with non-diabetic patients, patients with type 2 diabetes have a higher risk of osteoarthritis in the facet joints of L4, 5. Compared with diabetic patients with good or ideal glycemic control. Patients with poor glycemic control had more severe osteoarthritis of the L4, 5 and L5S1 facet joints. Patients with severe facet joint degeneration and poor glycemic control often suffered more from severe low back pain.
