P46. Do diabetics experience more cervical spine degenerative disc disease

Abstract

BACKGROUND CONTEXT Previous degenerative disc disease (DDD) literature has primarily focused on lumbar DDD. However, biomechanics of the cervical and lumbar spine are different. Cervical spine intervertebral discs (IVDs) are designed to withstand compression forces better than lumbar spine IVDs, but they are less equipped to tolerate bending stresses when compared to the lumbar spine. Therefore, it is unclear if co-morbidities associated with lumbar DDD are also correlated with cervical disc disease, and to our knowledge this has not previously been studied. PURPOSE Our primary objective was to determine if diabetics experience cervical DDD at a higher rate than non-diabetics. Our secondary objectives were to assess: 1) whether glycemic control (insulin use, blood glucose levels >200 and HgA1c levels >8.0%) or 2) other medical comorbidities were associated with cervical DDD. STUDY DESIGN/SETTING Retrospective cohort study in a tertiary care center. PATIENT SAMPLE A total of 308 diabetic and 315 non-diabetic patients. OUTCOME MEASURES Suzuki scoring of cervical spine intervertebral disc on MRI (0-3). METHODS Patients who underwent cervical spine MRI at our university for any reason between 2011-2019 were identified. A random group of 308 diabetic and 315 non-diabetic patients’ health data was extracted from the electronic medical record. Each intervertebral disc graded on MRI was scored from C2-T1 based on the Suzuki intervertebral disc score (0-3) in a blinded fashion. For univariate analysis, a one-sided Mann-Whitney test for non-parametric data was used to assess for an association between diabetes and DDD risk. The chi-square or Fisher's Exact test identified associations between comorbidities and Suzuki scores. All tests were adjusted for multiple comparisons using the Benjamini-Hochberg method. Multivariate data was analyzed using a best fit model. RESULTS Univariate analysis identified age, diabetes, hypertension, hypothyroidism, ASA class, cancer, pulmonary disease (COPD), number of previous cervical spine surgeries, peripheral vascular status, smoking and Medicare insurance as correlating with worse cumulative cervical spine disc disease (p 200 and HgA1c levels >8.0% were not associated with increased DDD in diabetics (p>0.05). On multivariate analysis, age and ASA class showed the highest correlation with cervical DDD. CONCLUSIONS Cervical spine DDD is multifactorial. We found diabetes diagnosis to be strongly correlated with cervical spine DDD. Additionally, multivariate analysis identified age and ASA class as best correlated with cervical DDD. Interestingly, BMI and poor glycemic control was not associated with cervical DDD. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.