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Review Article
Online Published: 07 Dec 2025
 


Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes

Ahmed K. Shukri, Yousef Aldosari, Ghada Salem Alshehri, Lubna Ladnah, Majd Saad Alqahtani, Khalid Yahya Ali Almudawi, Munira Ahmed Hussain Msawa, Huda Alwusaybie, Ohud Mesfer Alghamdi, Ali Mohammed Alamri, Mohannad A. Alzain.


Abstract
Cervical fusion, particularly anterior cervical discectomy and fusion, is the standard treatment for degenerative cervical disease. With the global rise in diabetes mellitus (DM), understanding its impact on surgical outcomes is crucial. This study systematically reviewed and meta-analyzed the influence of DM on nonunion and patient-reported quality-of-life (QOL) outcomes after cervical fusion. Following the PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched through April 2025. Comparative cohort studies reporting fusion outcomes in DM and non-DM patients were included. Primary outcomes were nonunion rates and postoperative patient-reported outcome measures, including the SF-12 physical component summary (PCS), and the visual analog scale (VAS) for pain. Study quality was appraised using the methodological index for non-randomized studies tool, and pooled estimates were calculated using a random-effects model. Six cohort studies (1,323 DM vs. 1,848 non-DM) met the inclusion criteria. The overall quality was moderate. DM did not significantly increase the risk of nonunion (OR: 0.93; 95% CI: 0.59-1.47; p-value = 0.81; I² = 42%). However, DM was associated with poorer QOL (SF-12 PCS: SMD −0.23; 95% CI: −0.44 to −0.02; p-value = 0.03) and higher postoperative pain (VAS: SMD 0.22; 95% CI: 0.11-0.34; p < 0.001). DM does not appear to increase nonunion risk after cervical fusion, likely reflecting the cervical spine’s favorable biomechanical and vascular milieu. Nonetheless, diabetic patients report worse functional recovery and pain outcomes, underscoring the need for rigorous perioperative diabetes management to optimize QOL.

Key words: Cervical fusion, anterior cervical discectomy and fusion, diabetes mellitus, meta-analysis, spine surgery.


 
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How to Cite this Article
Pubmed Style

Shukri AK, Aldosari Y, Alshehri GS, Ladnah L, Alqahtani MS, Almudawi KYA, Msawa MAH, Alwusaybie H, Alghamdi OM, Alamri AM, Alzain MA. Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. IJMDC. 2025; 9(11): 2893-2901. doi:10.24911/IJMDC.51-1760351063

Web Style

Shukri AK, Aldosari Y, Alshehri GS, Ladnah L, Alqahtani MS, Almudawi KYA, Msawa MAH, Alwusaybie H, Alghamdi OM, Alamri AM, Alzain MA. Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. https://www.ijmdc.com/?mno=290014 [Access: June 23, 2026]. doi:10.24911/IJMDC.51-1760351063

AMA (American Medical Association) Style

Shukri AK, Aldosari Y, Alshehri GS, Ladnah L, Alqahtani MS, Almudawi KYA, Msawa MAH, Alwusaybie H, Alghamdi OM, Alamri AM, Alzain MA. Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. IJMDC. 2025; 9(11): 2893-2901. doi:10.24911/IJMDC.51-1760351063


Vancouver/ICMJE Style

Shukri AK, Aldosari Y, Alshehri GS, Ladnah L, Alqahtani MS, Almudawi KYA, Msawa MAH, Alwusaybie H, Alghamdi OM, Alamri AM, Alzain MA. Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. IJMDC. (2025), [cited June 23, 2026]; 9(11): 2893-2901. doi:10.24911/IJMDC.51-1760351063


Harvard Style

Shukri, A. K., Aldosari, . Y., Alshehri, . G. S., Ladnah, . L., Alqahtani, . M. S., Almudawi, . K. Y. A., Msawa, . M. A. H., Alwusaybie, . H., Alghamdi, . O. M., Alamri, . A. M. & Alzain, . M. A. (2025) Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. IJMDC, 9 (11), 2893-2901. doi:10.24911/IJMDC.51-1760351063


Turabian Style

Shukri, Ahmed K., Yousef Aldosari, Ghada Salem Alshehri, Lubna Ladnah, Majd Saad Alqahtani, Khalid Yahya Ali Almudawi, Munira Ahmed Hussain Msawa, Huda Alwusaybie, Ohud Mesfer Alghamdi, Ali Mohammed Alamri, and Mohannad A. Alzain. 2025. Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. International Journal of Medicine in Developing Countries, 9 (11), 2893-2901. doi:10.24911/IJMDC.51-1760351063


Chicago Style

Shukri, Ahmed K., Yousef Aldosari, Ghada Salem Alshehri, Lubna Ladnah, Majd Saad Alqahtani, Khalid Yahya Ali Almudawi, Munira Ahmed Hussain Msawa, Huda Alwusaybie, Ohud Mesfer Alghamdi, Ali Mohammed Alamri, and Mohannad A. Alzain. "Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes." International Journal of Medicine in Developing Countries 9 (2025), 2893-2901. doi:10.24911/IJMDC.51-1760351063


MLA (The Modern Language Association) Style

Shukri, Ahmed K., Yousef Aldosari, Ghada Salem Alshehri, Lubna Ladnah, Majd Saad Alqahtani, Khalid Yahya Ali Almudawi, Munira Ahmed Hussain Msawa, Huda Alwusaybie, Ohud Mesfer Alghamdi, Ali Mohammed Alamri, and Mohannad A. Alzain. "Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes." International Journal of Medicine in Developing Countries 9.11 (2025), 2893-2901. Print. doi:10.24911/IJMDC.51-1760351063


APA (American Psychological Association) Style

Shukri, A. K., Aldosari, . Y., Alshehri, . G. S., Ladnah, . L., Alqahtani, . M. S., Almudawi, . K. Y. A., Msawa, . M. A. H., Alwusaybie, . H., Alghamdi, . O. M., Alamri, . A. M. & Alzain, . M. A. (2025) Cervical fusion in patients with diabetes mellitus: a systematic review and metaanalysis of nonunion and quality of life outcomes. International Journal of Medicine in Developing Countries, 9 (11), 2893-2901. doi:10.24911/IJMDC.51-1760351063




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