Surgical Outcome in Different Types of L4-L5 Degenerative Spondylolisthesis Based on CARDS Classification

Abstract

Background and Objective: Clinical and Radiologic Degenerative Spondylolisthesis (CARDS) classification is a relatively newer system than Meyerding’s to better categorize lumbar degenerative spondylolisthesis (LDS). The purpose of this study was to evaluate the outcome of surgery in patients with different types of LDS based on CARDS classification.
Materials and Methods: In this retrospective study, we assessed 49 (38 female and 11 male) patients with refractory L4-L5 LDS undergoing decompression, reduction and instrumented fusion in Imam Reza Hospital of Mashhad from February 2015 to January. Patients' classification, disability, and pain were assessed based on CARDS classification, Oswestry disability index (ODI), and visual analogue scale (VAS). Finally, a statistical analysis was performed to find out any correlation between different types of the disease and their clinical improvement.
Results: The mean follow-up period was 40.5±6.8 months (26 -72 months). Type B had the highest prevalence, and A had the lowest. Type C had the highest body mass index. Surgery could significantly improve both pain and disability in all types of the disease; however, we could not find any significant difference between the types in response to the surgery (p-value > 0.477). Gender distribution was similar among the types, but body mass index was the highest in type C.
Conclusion: Although all types of refractory L4-L5 LDS benefit from the operation, this improvement is not different among the types. It seems here, like other areas of the spine, that no significant relationship exists between the clinical and radiological characteristics.

Keywords: Lumbar Degenerative Spondylolisthesis, CARDS classification, Visual Analogue Scale, Oswestry Disability index