Related Experiment Video
Updated: Feb 26, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Reliability and Clinical Utility of the CARDS Classification for Degenerative Spondylolisthesis
Garret L Sobol1, Alan Hilibrand2, Ashley Davis3
1Rutgers New Jersey Medical School, Newark, NJ.
Insights
The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification is reliable for degenerative spondylolisthesis (DS). Type D, characterized by kyphotic alignment, presents distinct clinical features and improved surgical outcomes.
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.
Study Design:
Retrospective cohort study.
Objective:
The objective of this study is to determine the reliability and clinical utility of the of the proposed CARDS classification for degenerative spondylolisthesis.
Background:
The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system was recently proposed as an alternative to the Meyerding system for classifying degenerative spondylolisthesis (DS). Unlike Meyerding, CARDS considers other relevant radiographic findings such as disk space collapse and segmental kyphosis to stratify DS into 4 radiographically discreet types. Currently, no studies have been conducted to assess the clinical utility of the CARDS system.
Methods:
A total of 78 consecutive surgical patients with L4-L5 DS were rated as CARDS types A through D and Fleiss' κ for interobserver agreement was calculated. Then, demographics as well as preoperative and postoperative outcome scores (ODI, SF-12 mental and physical, VAS) were collected. The Kruskal-Wallis test was used to detect significant differences amongst CARDS types. An unpaired t test was used to compare individual CARDS types with all other subtypes combined.
Results:
Grading showed: 4 type A, 19 type B, 45 type C, and 8 type D (k=0.63). There was a statistically significant difference in preoperative back pain (P=0.046) between groups. CARDS type D had the highest mean back pain scores (8.8) of all subtypes which was significantly higher than mean back pain for all other subtypes combined (P=0.016). CARDS D showed the largest degree of improvement in all outcome measures. There was a trend towards an increased improvement in ODI (P=0.074) and SF-12 MCS (P=0.095) in the CARDS D subtype relative to the rest of the cohort.
Conclusions:
The CARDS classification system represents a reliable method for classifying cases of DS. Our results indicate that kyphotic segmental alignment (CARDS D) may be a less common, yet clinically distinct subset of DS characterized by worse preoperative back pain. CARDS type D cases may also show a greater degree of improvement in multiple outcome measures following surgical intervention.
