Skeletal radiology · 2025
Impact of diabetes mellitus on spinal injection two-week outcomes in patients with predominant lower extremity pain.
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Kim Y, Chee CG, Kang Y, Lee E, Lee JW
Аннотация
OBJECTIVE: To evaluate the effect of diabetes mellitus (DM) on the effectiveness of spinal injections in patients with predominant lower extremity pain.
MATERIALS AND METHODS: This retrospective study included 218 patients (109 with DM and 109 without DM, matched by propensity scores; mean age 68.4 ± 9.6 years; 111 men) who underwent lumbar spinal injections in 2017. Treatment effectiveness was assessed by calculating the relative reduction in numerical rating scale (NRS) scores 2 weeks post-injection. A generalized estimating equation analysis was conducted to determine whether DM influenced overall treatment outcomes and to perform subgroup analyses based on age (< 50 years, ≥ 50 years), sex, pain onset (acute/subacute [≤ 6 months] vs. chronic [> 6 months]), preprocedural pain severity (mild [NRS 0‒3], moderate [NRS 4‒6], severe [NRS 7‒10]), and pain symmetry (symmetric vs. asymmetric). Fisher's exact test was used to compare adverse event rates between patients with and without DM.
RESULTS: DM did not significantly impact the overall effectiveness of spinal injections 2 weeks after the injection (relative NRS reduction difference [95% confidence interval], -5.5% [-13.3% to 2.2%]; P = 0.163). However, patients with DM and chronic pain (-16.7% [-25.6% to -7.9%], P < 0.001) or mild preprocedural pain (-20.2% [-37.1% to -3.2%], P = 0.019) exhibited reduced treatment effects 2 weeks after the injection. Adverse event rates did not significantly differ between groups (P > 0.99).
CONCLUSION: There was no difference in the spinal injection effectiveness between patients with and without DM 2 weeks after the injection. However, their therapeutic effect may be diminished in patients with chronic or mild preprocedural pain, warranting consideration of a potential diagnostic overlap with diabetic neuropathy.
MATERIALS AND METHODS: This retrospective study included 218 patients (109 with DM and 109 without DM, matched by propensity scores; mean age 68.4 ± 9.6 years; 111 men) who underwent lumbar spinal injections in 2017. Treatment effectiveness was assessed by calculating the relative reduction in numerical rating scale (NRS) scores 2 weeks post-injection. A generalized estimating equation analysis was conducted to determine whether DM influenced overall treatment outcomes and to perform subgroup analyses based on age (< 50 years, ≥ 50 years), sex, pain onset (acute/subacute [≤ 6 months] vs. chronic [> 6 months]), preprocedural pain severity (mild [NRS 0‒3], moderate [NRS 4‒6], severe [NRS 7‒10]), and pain symmetry (symmetric vs. asymmetric). Fisher's exact test was used to compare adverse event rates between patients with and without DM.
RESULTS: DM did not significantly impact the overall effectiveness of spinal injections 2 weeks after the injection (relative NRS reduction difference [95% confidence interval], -5.5% [-13.3% to 2.2%]; P = 0.163). However, patients with DM and chronic pain (-16.7% [-25.6% to -7.9%], P < 0.001) or mild preprocedural pain (-20.2% [-37.1% to -3.2%], P = 0.019) exhibited reduced treatment effects 2 weeks after the injection. Adverse event rates did not significantly differ between groups (P > 0.99).
CONCLUSION: There was no difference in the spinal injection effectiveness between patients with and without DM 2 weeks after the injection. However, their therapeutic effect may be diminished in patients with chronic or mild preprocedural pain, warranting consideration of a potential diagnostic overlap with diabetic neuropathy.