Study design:

Retrospective cohort study OBJECTIVE: To compare outcomes among Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) subtypes in patients undergoing posterior lumbar decompression and fusion (PLDF) or transforaminal lumbar interbody fusion (TLIF) and evaluate the CARDS system as a tool to guide clinical decisions regarding the treatment of degenerative spondylolisthesis (DS).

Methods:

Patients undergoing PLDF or TLIF for DS from 2010-2020 were identified. Patients were grouped by preoperative CARDS classification. Multivariate analysis was utilized to determine the effects of treatment approach on one-year PROMs and 90-day surgical outcomes.

Results:

A total of 1,056 patients were included:148 patients with Type A DS, 323 Type B, 525 Type C, and 60 Type D. Patients with CARDS Types A and C who underwent PLDF experienced longer length of stay and were less likely to be discharged home. There were no differences in revisions, complications, or readmissions between surgical approaches. CARDS Type A patients undergoing PLDF were less likely to achieve MCID for VAS Back (36.8% vs 76.7%, p=0.013). There were no other significant differences in PROMs among CARDS subtypes. TLIF independently predicted better VAS Leg pain improvement at one-year follow-up (β=-2.92, p=0.017) among CARDS Type A patients. Multivariable analysis demonstrated no significant difference in PROMs by surgical approach among other CARDS subtypes.

Conclusion:

Patients 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 Type B and C) showed no benefit from additional interbody placement.