Reliability and Clinical Utility of the CARDS Classification for Degenerative Spondylolisthesis

Area of Science:

• Orthopedics
• Neurosurgery
• Radiology

Background:

• Degenerative spondylolisthesis (DS) requires reliable classification.
• The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) system stratifies DS into 4 types, considering disk collapse and kyphosis.
• CARDS offers an alternative to the Meyerding system, with no prior assessment of its clinical utility.

Purpose of the Study:

• To evaluate the reliability and clinical utility of the CARDS classification for DS.
• To compare the clinical characteristics and surgical outcomes of different CARDS types.

Main Methods:

• Retrospective cohort study of 78 surgical patients with L4-L5 DS.
• Interobserver agreement assessed using Fleiss' kappa for CARDS classification (A-D).
• Demographics, preoperative/postoperative outcomes (ODI, SF-12, VAS) analyzed using Kruskal-Wallis and t-tests.

Main Results:

• CARDS classification showed good interobserver agreement (κ=0.63).
• CARDS type D (kyphotic alignment) exhibited significantly higher preoperative back pain.
• CARDS type D demonstrated the greatest improvement in outcome measures post-surgery.

Conclusions:

• The CARDS classification system is a reliable tool for classifying DS.
• CARDS type D represents a distinct clinical subset of DS with severe preoperative pain.
• Surgical intervention in CARDS type D may yield superior outcomes.