• World Neurosurg · Jul 2023

    Comparing Posterior Lumbar Decompression and Fusion and Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Spondylolisthesis as Assessed by the CARDS Classification System.

    • Tariq Ziad Issa, Yunsoo Lee, Mark J Lambrechts, Khoa S Tran, Nicholas Siegel, Sandy Li, Alexander Becsey, Kevin Endersby, Ian David Kaye, Jeffrey A Rihn, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, and Christopher K Kepler.
    • Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
    • World Neurosurg. 2023 Jul 1; 175: e861e875e861-e875.

    ObjectiveIn a retrospective cohort study, we compared the outcomes among clinical and radiographic degenerative spondylolisthesis (CARDS) subtypes for patients undergoing posterior lumbar decompression and fusion (PLDF) or transforaminal lumbar interbody fusion (TLIF) and evaluated the CARDS system as a tool to guide clinical decisions regarding the treatment of degenerative spondylolisthesis (DS).MethodsPatients undergoing PLDF or TLIF for DS from 2010 to 2020 were identified. The patients were grouped by the preoperative CARDS classification. Multivariate analysis was used to determine the effects of the treatment approach on the 1-year patient-reported outcome measures (PROMs) and 90-day surgical outcomes.ResultsA total of 1056 patients were included: 148 patients with type A DS, 323 with type B, 525 with type C, and 60 with type D. Patients with CARDS types A and C who underwent PLDF experienced a longer length of stay and were less likely to be discharged home. No differences were found in the incidence of revisions, complications, or readmissions between the surgical approaches. Patients with CARDS type A undergoing PLDF were less likely to achieve a minimal clinically important difference for back pain (36.8% vs. 76.7%; P = 0.013). No other significant differences were found in the PROMs among the CARDS subtypes. TLIF independently predicted for better leg pain improvement using the visual analog scale at 1 year of follow-up (β = -2.92; P = 0.017) for patients with CARDS type A. Multivariable analysis demonstrated no significant differences in PROMs by surgical approach among the other CARDS subtypes.ConclusionsPatients with disc space collapse and endplate apposition (CARDS type A) appear to benefit from TLIF. However, patients with lumbar spondylolisthesis without disc space collapse or kyphotic angulation (CARDS types B and C) showed no benefit from additional interbody placement.Copyright © 2023 Elsevier Inc. All rights reserved.

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