ArticlePloS one2026
Association of type 2 diabetes mellitus with postoperative outcomes following single-level endoscopic lumbar interbody fusion through a posterior approach: A global propensity score-matched cohort study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundType 2 diabetes mellitus (T2DM) has been associated with impaired bone healing and may increase the risk of pseudarthrosis after lumbar fusion. Its impact after endoscopic lumbar interbody fusion (Endo-LIF) performed through a posterior approach remains unclear.
methodsIn this retrospective cohort study using the TriNetX Global Collaborative Network, adults undergoing single-level Endo-LIF through a posterior approach between 2015 and 2025 were identified from ICD-10-PCS procedure codes, which record a percutaneous endoscopic interbody fusion approached from behind but do not distinguish uniportal from biportal technique or posterior from transforaminal variants. Patients with and without T2DM were propensity score-matched 1:1 on demographic and clinical variables. The primary outcome was code-defined pseudarthrosis (ICD-10-CM M96.0) within three years; secondary outcomes were 90-day complications and one-year healthcare utilization. Time-to-event outcomes were analyzed with Kaplan-Meier estimates, log-rank tests and Cox regression.
resultsAfter matching, 755 patients remained per cohort. Early complications and healthcare utilization were comparable (all p > 0.05). Code-defined pseudarthrosis was recorded more often with T2DM at every interval (observed proportions 11.5% vs 6.2% by 36 months; all p < 0.01). Kaplan-Meier cumulative incidence at 36 months was 12.0% (95% CI 9.8-14.6) with T2DM versus 6.4% (95% CI 4.9-8.5) without (log-rank p = 0.0003), an absolute risk difference of 5.5% (95% CI 2.6% to 8.5%); the hazard ratio was 1.90 (95% CI 1.33-2.71).
conclusionIn this database cohort, T2DM was associated with a higher rate of code-defined pseudarthrosis after single-level Endo-LIF, despite similar short-term outcomes. Because the outcome was code-defined and the procedure codes do not characterize operative technique, these findings describe an association only: they do not establish that T2DM independently causes radiographic nonunion, and are consistent with, but do not demonstrate, a contribution of systemic metabolic factors to long-term fusion.
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