Impact of diabetes mellitus on minimally invasive spine surgery outcome: A systematic review

Background: Minimally invasive spine (MIS) surgery has been shown to reduce tissue trauma and perioperative morbidity; however, its safety and effectiveness in diabetic patients remain uncertain. Here, we evaluated the impact of diabetes mellitus on postoperative complications and outcomes following minimally invasive lumbar spine procedures. Methods: This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in The International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive literature search was performed across PubMed, Scopus, Embase, and Web of Science databases through January 2025. Studies were included if they evaluated adult diabetic patients undergoing MIS lumbar discectomy, interbody fusion, or decompression. Methodological quality was assessed using the Newcastle–Ottawa scale. Results: A total of 16 studies were included: eleven focused on interbody fusion or discectomy ( n = 2041) and five on decompression-only procedures ( n = 1256). The majority of studies reported similar rates of surgical complications between diabetic and nondiabetic patients. However, some identified increased risks for medical complications, prolonged hospitalization, or pseudarthrosis in people with diabetes. Although functional outcomes, including pain scores and disability indices, were generally comparable across groups on long-term follow-up, diabetic patients occasionally reported lower postoperative quality of life scores. Due to heterogeneity in study design and reporting, a meta-analysis was not performed. Conclusion: Despite some variability in perioperative risks, MIS appears to offer safe and effective outcomes for diabetic patients. The long-term benefits are largely similar to those observed in nondiabetic populations.