Article
The clinical and radiographic degenerative spondylolisthesis classification and its predictive value
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Authors
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Henrik Bäcker
- Charité Berlin, Berlin, Germany
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Jack Hanlon
- Auckland City Hospital, Auckland, New Zealand
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Michael Johnson
- Epworth Richmond Hospital, Richmond, Australia
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Peter Turner
- Royal Melbourne Hospital, Parkville, Australia
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John Cunningham
- Royal Melbourne Hospital, Parkville, Australia
| Published: | October 23, 2023 |
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Outline
Text
Objectives: A new classification has been introduced for degenerative spondylolisthesis (DS). This clinical and radiographic degenerative spondylolisthesis (CARDS) classification was developed to differentiate between advanced disc collapse, without kyphosis (A), partially preserved disc space with less (B) or more than 5.0 mm translation (C) and kyphotic alignment pattern (D).
Our study aimed to analyze the functional and radiographic outcome following degenerative spondylolisthesis surgery.
Methods: A retrospective trial of our prospective database was performed using the Australian spine registry. Data on demographics, patient reported outcome measures applying the Oswestry Disability Index (ODI), EQ-5D-3L scores and changes in radiographic measurements were analyzed. Based on the preoperative findings all x-rays were classified applying the CARDS classification as described above.
Results and conclusion: Between 2018 and 2021 a total of 54 patients at a mean age of 65.33±11.31years. A majority of patients were female in 61.1% of cases. The majority of cases were of CARDS type C in 46.3%, followed by type B in 29.6%. CARDS type A and D were observed in 18.5% respectively 5.6%. Preoperatively, the L4/5 lordosis was 19.77±6.33° and lumbar lordosis 43.94±12.84°. After surgery the alignment changed significantly for L4/5 lordosis to 23.49±8.81° (p<0.05).
For the individual CARDS classification the ODI was 34.78±17.36 (type A), 40.53±11.00 (type B), 43.84±12.94 and 50.00±14.42 (type D) (Pearson coefficient 0.284, p=0.041). In longterm this changed to 22.71±16.05, 28.71±21.24, 16.88±13.75 respectively 20.00±20.79. Similar improvements were observed for the EQ-5D-3L from 63.20±12.64, 52.00±20.07, 57.60±22.11, respectively 56.67±11.55 before surgery and 74.00±18.07, 67.00±28.07, 84.18±11.22, respectively 78.00±0.00.
This study shows that the CARDS classification correlates significantly with the preoperative ODI scores and can be used to predict the functional outcome. It will help to simplify the diagnostics and operative planning where especially type A and D benefit from single level fusion
