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J Clin Neurosci. 2016 May;27:99-101. doi: 10.1016/j.jocn.2015.07.025. Epub 2015 Dec 30.

Diabetes and cervical myelopathy.

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Marcus Neuroscience Institute at the Boca Raton Regional Hospital, Boca Raton, FL 33486, USA. Electronic address:
Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, 111 E. 210th Street Bronx, NY 10467, USA.


Diabetes may affect the typical physical findings associated with cervical spondylotic myelopathy, as coexisting diabetic neuropathy may dampen expected hyperreflexia and also produce non-dermatomal extremity numbness. Most large studies of surgically treated diabetic patients with cervical spondylotic myelopathy have focused upon infection rates rather than exploring any differences in the presenting physical signs. We conducted a retrospective study of the pattern of presenting neurological signs and symptoms and of the clinical outcomes in 438 patients surgically treated for cervical spondylotic myelopathy, 79 of whom had diabetes. Compared with non-diabetic patients, those with diabetes were slightly older and had lower preoperative modified Japanese Orthopaedic Association (mJOA) scores. Those with diabetes also had a significantly higher incidence of hyporeflexia and a higher incidence of a positive Babinski sign, but there was no difference in the appearance of the Hoffman sign. The magnitude of mJOA improvement after surgery was comparable. We conclude that diabetes may alter the typical signs and symptoms of cervical spondylotic myelopathy and suggest that knowledge of the differences may aid in securing a prompt and accurate diagnosis.


Babinski sign; Cervical myelopathy; Diabetes; Diabetic peripheral neuropathy; Hoffman sign; Neurological examination

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