The Joe-Lin Operative Classification System for Pediatric Lumbosacral Spondylolysis and Spondylolisthesis

To propose and validate a novel and comprehensive classification of lumbosacral spondylolysis and spondylolisthesis in the pediatric population according to surgical managements.

Cases of pediatric lumbosacral (L5/S1 level) spondylolysis and spondylolisthesis were reviewed. Lumbar Japanese Orthopedics Association score, health-related quality of life, spondylolisthesis, lumbosacral disc degeneration, and dysplastic features were included for evaluation of outcomes after surgery. We also conducted a reliability study to assess the classification.

A classification containing 4 types and a tentative treatment algorithm were proposed: type 1, direct pars repair without segmented fusion, for which the pedicle screw-U rod system is suitable; type 2, simple L5-S1 fusion; type 3, simple L4-S1 fusion; and type 4, simple L5-S2 fusion. All types of spondylolisthesis were suggested to achieve complete reduction and decompression. A total of 162 patients were included and we also reviewed the outcomes of patients in each type. All patients achieved satisfied outcomes. The reliability study showed that the average interobserver agreement was 89.5% (range, 85.2%-92.6%), with κ value of 0.862 (range, 0.802-0.901). Intraobserver agreement ranged from 88.9% to 92.6%, with an average κ value of 0.868 (range, 0.835-0.901).

In our study, we proposed and validated a novel comprehensive classification of pediatric lumbosacral spondylolysis and spondylolisthesis. The pedicle screw-U rod system provided more benefits in the treatment of simple lumbosacral spondylolysis, and fusion from L5 to S2 combined with S2 screw would also benefit patients with high-degree spondylolisthesis.