Higher Improvement in Patient-Reported Outcomes Can Be Achieved After Transforaminal Lumbar Interbody Fusion for Clinical and Radiographic Degenerative Spondylolisthesis Classification Type D Degenerative Lumbar Spondylolisthesis

Xi Chen; Liang Xu; Yong Qiu; Zhong-Hui Chen; Qing-Shuang Zhou; Song Li; Xu Sun

doi:10.1016/j.wneu.2018.02.175

Higher Improvement in Patient-Reported Outcomes Can Be Achieved After Transforaminal Lumbar Interbody Fusion for Clinical and Radiographic Degenerative Spondylolisthesis Classification Type D Degenerative Lumbar Spondylolisthesis

World Neurosurg. 2018 Jun:114:e293-e300. doi: 10.1016/j.wneu.2018.02.175. Epub 2018 Mar 7.

Authors

Xi Chen¹, Liang Xu², Yong Qiu¹, Zhong-Hui Chen², Qing-Shuang Zhou¹, Song Li², Xu Sun³

Affiliations

¹ Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
² Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
³ Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China. Electronic address: drsunxu@163.com.

PMID: 29524706
DOI: 10.1016/j.wneu.2018.02.175

Abstract

Background: Clinical and radiographic degenerative spondylolisthesis (CARDS) classification defines a distinct subset of patients with kyphotic angulation at the involved segment (type D). Research using CARDS classification to investigate motion characteristics at involved segments or patient-related outcomes (PROs) following surgical intervention is sparse. We investigated the relationship between CARDS type D spondylolisthesis and dynamic instability and PROs in type D versus non-type D spondylolisthesis.

Methods: We reviewed consecutive patients who received transforaminal lumbar interbody fusion for L4-5 spondylolisthesis between 2009 and 2015. Patients were assigned into type D and non-type D groups. Translational motion was determined by upright lumbar lateral radiography with supine sagittal magnetic resonance imaging or flexion and extension radiography. Demographics, radiographic parameters, and PROs were evaluated.

Results: Type D and non-type D groups comprised 34 and 163 patients, respectively. Compared with non-type D, type D group was characterized by lordotic angulation loss and higher degree of olisthesis on upright radiographs and demonstrated higher translational motion on upright lumbar lateral radiography with supine sagittal magnetic resonance imaging analysis. After surgery, mean reduction rate was significantly higher in type D group; type D had less slippage, but differences in slip angle and disc height were not significant. Preoperative Oswestry Disability Index and visual analog scale for back pain scores were higher in type D group. Type D spondylolisthesis and dynamic instability were associated with achieving minimal clinically important differences in PROs.

Conclusions: CARDS type D spondylolisthesis is a distinct subset associated with dynamic instability and worse PROs. Higher improvement in PROs can be achieved in CARDS type D spondylolisthesis after surgery.

Keywords: CARDS classification; Degenerative lumbar spondylolisthesis; Instability; Patient-reported outcomes.

MeSH terms

Adult
Aged
Disability Evaluation
Female
Humans
Intervertebral Disc Degeneration / complications*
Longitudinal Studies
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / surgery*
Lumbosacral Region
Magnetic Resonance Imaging
Male
Middle Aged
Patient Reported Outcome Measures*
Radiography
Retrospective Studies
Spinal Fusion / methods*
Spondylolisthesis / classification
Spondylolisthesis / complications*
Spondylolisthesis / diagnostic imaging
Spondylolisthesis / surgery*
Tomography Scanners, X-Ray Computed
Visual Analog Scale