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; Christopher K. Kepler

doi:10.1016/j.wneu.2023.04.036

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, Christopher K. Kepler

Division of Spine

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Objective: In 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). Methods: Patients 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. Results: A 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. Conclusions: 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 types B and C) showed no benefit from additional interbody placement.

Original language	English
Pages (from-to)	e861-e875
Journal	World neurosurgery
Volume	175
DOIs	https://doi.org/10.1016/j.wneu.2023.04.036
State	Published - Jul 2023

Keywords

Degenerative spondylolisthesis
Lumbar spine
Patient reported outcomes
Posterior lumbar decompression and fusion
Transforaminal lumbar interbody fusion

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10.1016/j.wneu.2023.04.036

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Issa, T. Z., Lee, Y., Lambrechts, M. J., Tran, K. S., Siegel, N., Li, S., Becsey, A., Endersby, K., Kaye, I. D., Rihn, J. A., Kurd, M. F., Canseco, J. A., Hilibrand, A. S., Vaccaro, A. R., Schroeder, G. D., & Kepler, C. K. (2023). Comparing Posterior Lumbar Decompression and Fusion and Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Spondylolisthesis as Assessed by the CARDS Classification System. World neurosurgery, 175, e861-e875. https://doi.org/10.1016/j.wneu.2023.04.036

@article{3495b624000a4eb5b12e39d1fd206523,

title = "Comparing Posterior Lumbar Decompression and Fusion and Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Spondylolisthesis as Assessed by the CARDS Classification System",

abstract = "Objective: In 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). Methods: Patients 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. Results: A 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. Conclusions: 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 types B and C) showed no benefit from additional interbody placement.",

keywords = "Degenerative spondylolisthesis, Lumbar spine, Patient reported outcomes, Posterior lumbar decompression and fusion, Transforaminal lumbar interbody fusion",

author = "Issa, \{Tariq Ziad\} and Yunsoo Lee and Lambrechts, \{Mark J.\} and Tran, \{Khoa S.\} and Nicholas Siegel and Sandy Li and Alexander Becsey and Kevin Endersby and Kaye, \{Ian David\} and Rihn, \{Jeffrey A.\} and Kurd, \{Mark F.\} and Canseco, \{Jose A.\} and Hilibrand, \{Alan S.\} and Vaccaro, \{Alexander R.\} and Schroeder, \{Gregory D.\} and Kepler, \{Christopher K.\}",

note = "Funding Information: The authors would like to thank Matthew Sherman for assistance with the statistical analysis. Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

month = jul,

doi = "10.1016/j.wneu.2023.04.036",

language = "English",

volume = "175",

pages = "e861--e875",

journal = "World neurosurgery",

issn = "1878-8750",

}

Issa, TZ, Lee, Y, Lambrechts, MJ, Tran, KS, Siegel, N, Li, S, Becsey, A, Endersby, K, Kaye, ID, Rihn, JA, Kurd, MF, Canseco, JA, Hilibrand, AS, Vaccaro, AR, Schroeder, GD & Kepler, CK 2023, 'Comparing Posterior Lumbar Decompression and Fusion and Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Spondylolisthesis as Assessed by the CARDS Classification System', World neurosurgery, vol. 175, pp. e861-e875. https://doi.org/10.1016/j.wneu.2023.04.036

TY - JOUR

T1 - Comparing Posterior Lumbar Decompression and Fusion and Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Spondylolisthesis as Assessed by the CARDS Classification System

AU - Issa, Tariq Ziad

AU - Lee, Yunsoo

AU - Lambrechts, Mark J.

AU - Tran, Khoa S.

AU - Siegel, Nicholas

AU - Li, Sandy

AU - Becsey, Alexander

AU - Endersby, Kevin

AU - Kaye, Ian David

AU - Rihn, Jeffrey A.

AU - Kurd, Mark F.

AU - Canseco, Jose A.

AU - Hilibrand, Alan S.

AU - Vaccaro, Alexander R.

AU - Schroeder, Gregory D.

AU - Kepler, Christopher K.

N1 - Funding Information: The authors would like to thank Matthew Sherman for assistance with the statistical analysis. Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: © 2023 Elsevier Inc.

PY - 2023/7

Y1 - 2023/7

N2 - Objective: In 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). Methods: Patients 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. Results: A 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. Conclusions: 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 types B and C) showed no benefit from additional interbody placement.

AB - Objective: In 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). Methods: Patients 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. Results: A 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. Conclusions: 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 types B and C) showed no benefit from additional interbody placement.

KW - Degenerative spondylolisthesis

KW - Lumbar spine

KW - Patient reported outcomes

KW - Posterior lumbar decompression and fusion

KW - Transforaminal lumbar interbody fusion

UR - https://www.scopus.com/pages/publications/85163196646

U2 - 10.1016/j.wneu.2023.04.036

DO - 10.1016/j.wneu.2023.04.036

M3 - Article

C2 - 37075895

AN - SCOPUS:85163196646

SN - 1878-8750

VL - 175

SP - e861-e875

JO - World neurosurgery

JF - World neurosurgery

ER -

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

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Keywords

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