{ "abstract": "Background: Type 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. Methods: In 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. Results: After 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). Conclusion: In 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.", "abstract_shown": true, "affiliations": [ "The International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan", "Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam", "Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan", "Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan", "Department of Orthopedic Surgery, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan" ], "article_type": "Research Article", "arxiv": null, "author_total": 5, "authors": [ { "affs": [ 0 ], "name": "Phuoc Giau Dang" }, { "affs": [ 1 ], "name": "Yu-Pin Chen" }, { "affs": [ 2 ], "name": "Tan Thanh Nguyen" }, { "affs": [ 3 ], "name": "Dat Huu Nguyen" }, { "affs": [ 4 ], "name": "Yi-Jie Kuo" } ], "bibtex": "https://research.draconitic.com/paper/cngrh1dd9m94h.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0358422", "fulltext_url": null, "id": "cngrh1dd9m94h", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0358422", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2734|Spine and Intervertebral Disc Pathology" ], [ "plos", "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus/Type 2 diabetes" ], [ "plos", "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus/Type 2 diabetes/Type 2 diabetes risk" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus/Type 2 diabetes" ], [ "plos", "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus/Type 2 diabetes/Type 2 diabetes risk" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Endoscopy" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Minimally invasive surgery" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Nervous system procedures/Spinal fusion" ] ], "openalex": "W7213552719", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358422&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-18", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/cngrh1dd9m94h.ris", "sources": [ { "first_seen": "2026-10-30T12:17:49Z", "native_id": "10.1371/journal.pone.0358422", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0358422" } ], "subjects": [ { "field": "medicine", "origin": "plos:endocrinology", "subfield": "endocrinology-metabolism" }, { "field": "medicine", "origin": "plos:surgical and invasive medical procedures", "subfield": "surgery" } ], "title": "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", "title_text": "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", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:49Z", "url": "https://research.draconitic.com/paper/cngrh1dd9m94h", "venue": "PLOS One", "versions": [] }