Which subtypes of degenerative lumbar spondylolisthesis are suitable for oblique lumbar interbody fusion? A retrospective study in China based on the clinical and radiographic degenerative spondylolisthesis classification.

Abstract

Study design: Retrospective study.

Purpose: To evaluate the radiological characteristics of degenerative lumbar spondylolisthesis (DS) and analyze the suitability of oblique lumbar interbody fusion (OLIF) for different DS subtypes.

Overview of literature: OLIF has gained distinction for its minimal invasiveness and quicker recovery. Despite its promising effectiveness in treating DS, variations in patient characteristics necessitate precise surgical technique selection. The clinical and radiographic degenerative spondylolisthesis (CARDS) classification aids in identifying suitable DS subtypes.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups.

Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments.

Conclusions: Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.