Abstract
BackgroundThe aim of this study was to compare the reliability and validity of the CARDS and French classification systems for lumbar DS.MethodsBetween May 2013 and December 2016, 158 consecutive patients diagnosed with single-level lumbar DS were included in this study, and all underwent lumbar fusion. All patients underwent long-cassette standing anterioposterior and lateral radiographs of the spine preoperatively and postoperatively. The images were graded according to the CARDS and French classification systems by two orthopedic spinal surgeons and two orthopedic spinal fellows, independently. Clinical outcome measures used were the visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey. Clinical data were collected before surgery and 1 year after surgery.ResultsA total of 146 patients were finally included in this study and followed up for at least 1 year. When grading using the CARDS system, the κ values for inter- and intraobserver reliability were 0.837 and 0.869, respectively, representing perfect agreement. The interobserver κ value for the French classification was 0.693 and the intraobserver κ value was 0.743, both representing substantial agreement. CARDS Type D patients have higher preoperative back pain scores and better improvement after surgery compared with non-Type D patients. Mean back and leg pain was worse in French Type 5 patients, while the most significant improvement was also seen in Type 5 patients after surgery.ConclusionsBoth CARDS and French classification systems have acceptable reliability and validity. The CARDS system is easier to utilize and has better reliability.Level of evidenceIV
Highlights
The aim of this study was to compare the reliability and validity of the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) and French classification systems for lumbar degenerative spondylolisthesis (DS)
Surgery is recommended for patients who are refractory to conservative treatment, the optimal
A total of 1168 grading times were made by four graders using the French classification system (146*4*2), including Type 1 (34.6%), Type 2 (17.2%), Type 3 (30.4%), Type 4 (9.4%), and Type 5 (8.4%)
Summary
The aim of this study was to compare the reliability and validity of the CARDS and French classification systems for lumbar DS. Lumbar DS was classified based on etiology and slip grade, which provides limited clinical utility in guiding surgical treatment since the magnitude of slip rarely exceeds 30% [5, 6]. In 2014, Kepler and his colleagues proposed The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system of lumbar DS based on radiographic characteristics and clinical manifestations [7]. No data or studies have compared the reliability and validity between the CARDS and French classifications. We retrospectively followed 158 patients with single-level lumbar DS, aiming to compare the reliability and validity between the two classifications
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