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Published on: March 23, 2019
Effect of Clinical and Radiographic Degenerative Spondylolisthesis Classification on Patient-reported Outcomes and
Brian A Karamian1, Hannah A Levy, Stephen L DiMaria
1Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA.
Study Design:
Retrospective cohort study.
Objectives:
To determine whether preoperative clinical and radiographic degenerative spondylolisthesis (CARDS) classification is associated with differences in patient-reported outcomes and spinopelvic parameters after posterior decompression and fusion for L4-L5 degenerative spondylolisthesis (DS).
Summary:
The CARDS classification for lumbar DS, an alternative to the Meyerding system, considers additional radiographic findings such as disc space collapse and segmental kyphosis and stratifies DS into 4 radiographically distinct classes. Although CARDS has been shown to be a reliable and reproducible method for classifying DS, very few studies have assessed whether the CARDS types represent distinct clinical entities.
Patients And Methods:
A retrospective cohort analysis was conducted on patients with L4-L5 DS who underwent posterior lumbar decompression and fusion. Changes in spinopelvic alignment and patient-reported outcomes measures, including recovery ratios and percentage of patients achieving the minimal clinically important difference, were compared among patients in each CARDS classification 1-year postoperatively using analysis of variance or Kruskal-Wallis H with Dunn post hoc analysis. Multiple linear regression determined whether CARDS groups significantly predicted patient-reported outcomes measures, lumbar lordosis (LL), and pelvic incidence-lumbar lordosis mismatch (PI-LL) while controlling for demographic and surgical characteristics.
Results:
Preoperative type B spondylolisthesis predicted decreased improvement in "physical component and mental component score of the short form-12" compared with type A spondylolisthesis (β-coefficient = -5.96, P = 0.031) at 1 year. Significant differences were found between CARDS groups with regards to ΔLL (A: -1.63 degrees vs B: -1.17 degrees vs C: 2.88 degrees vs D: 3.19 degrees, P = 0.010) and ΔPI-LL (A: 1.02 degrees vs B: 2.09 degrees vs C: -2.59 degrees vs D: -3.70 degrees, P = 0.012). Preoperative type C spondylolisthesis was found to predict increased LL (β-coefficient = 4.46, P = 0.0054) and decreased PI-LL (β-coefficient = -3.49, P = 0.025) at 1 year compared with type A spondylolisthesis.
Conclusions:
Clinical and radiographic outcomes differed significantly by preoperative CARDS classification type for patients undergoing posterior decompression and fusion for L4-L5 DS.
Level Of Evidence:
Level III.
