The Joe-Lin Operative Classification System for Pediatric Lumbosacral Spondylolysis and Spondylolisthesis


To propose and validate a novel and comprehensive classification of lumbosacral spondylolysis and spondylolisthesis in the pediatric population according to surgical managements.


Cases of pediatric lumbosacral (L5/S1 level) spondylolysis and spondylolisthesis were reviewed. Lumbar Japanese Orthopedics Association (JOA) score, health related quality of life (HRQOL) which was assessed, spondylolisthesis, lumbosacral disc degenerative, and dysplastic features were included for evaluation of outcomes after surgery. We also conducted a reliability study to assess the classification.


A classification contained four types and a tentative treatment algorithm were proposed. Type 1: type of direct pars repair without segmented fusion and pedicle screw-U rod system would be suitable. Type 2: type of simply L5-S1 fusion. Type 3: type of simply L4-S1 fusion. Type 4: type of simply L5-S2 fusion. All types of spondylolisthesis were suggested to achieve complete reduction and decompression. A total of 162 patients were included and we also reviewed the outcomes of patients in each type. All patients achieved satisfied outcomes. The reliability study showed the average inter-observer agreement was 89.5% (85.2%∼92.6%), with κ value of 0.862 (0.802∼0.901). And intra-observer agreement ranged from 88.9% to 92.6% with an average κ value of 0.868 (0.835∼∼0.901).


In our study, we proposed and validated a novel comprehensive classification of pediatric lumbosacral spondylolysis and spondylolisthesis. Pedicle screw-U rod system provided more benefits in the treatment of simple lumbosacral spondylolysis, and fusion from L5 to S2 combined with S2 screw would also benefit patients with high-degree spondylolisthesis.


classification; pediatric; reliability study; spondylolisthesis; spondylolysis.

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