Effect of Surgical Approach on Patient-reported Outcomes of Lumbar Fusion for Degenerative Spondylolisthesis: Should Grade Influence Approach?

Authors

• Alec Giakas
• Teeto Ezeonu
• Rajkishen Narayanan
• Jonathan Dalton
• Rachel Huang
• Yunsoo Lee
• Alex Christianson
• Catherine Alvaro
• Jose Pena
• Nathan Thomas
• Jose A Canseco
• Mark F Kurd
• Ian David Kaye
• Barrett I Woods
• Alan S Hilibrand
• Alexander R Vaccaro
• Gregory D Schroeder
• Christopher K Kepler

Publication/Presentation Date

3-1-2026

Abstract

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: The present study aims to compare outcomes for patients undergoing spinal fusion through PLDF and TLIF and determine whether specific radiographic characteristics, based upon both the CARDS and Meyerding classifications, might influence optimal fusion technique.

SUMMARY OF BACKGROUND DATA: Despite the significant prevalence and high disease burden of degenerative spondylolisthesis (DS), consensus regarding surgical management is still lacking.

METHODS: Adult patients (≥18 years old) who underwent primary single-level lumbar fusion for degenerative spondylolisthesis were retrospectively identified. Preoperative flexion-and-extension lateral radiographs were reviewed to classify DS using the Meyerding grading system, as well as the validated Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system. PROM scores were collected preoperatively and 1 year postoperatively and included the Oswestry Disability Index (ODI), Visual Analog Scale back and leg (VAS back and VAS leg, respectively), and the mental and physical component of the short-form 12 survey (MCS and PCS).

RESULTS: A total of 594 patients were identified. Patients with CARDS type A spondylolisthesis experienced greater improvement in ODI (-11.02 vs. -3.06, P =0.005) when they underwent TLIF; however, patients with CARDS class B experienced greater ODI improvement after a PLDF (-14.33 vs. -5.45, P < 0.001). Patients with Meyerding grade 1 spondylolisthesis experienced greater improvement in ODI (-10.15 vs. -6.27, P =0.006) and MCS (5.68 vs. 2.87, P =0.011) when they underwent PLDF compared with TLIF. There were no other differences in PROM improvement between approaches for other grades and classes. After controlling for patient characteristics, these differences persisted on linear regression analysis.

CONCLUSION: Although there are several factors to consider, these results show that PLDF may be the optimal approach for degenerative spondylolisthesis patients with milder degrees of vertebral slippage. Patients with advanced disc collapse, endplate apposition, and kyphosis may benefit more from TLIF.

Volume

39

Issue

2

First Page

54

Last Page

59

ISSN

2380-0194

Published In/Presented At

Giakas, A., Ezeonu, T., Narayanan, R., Dalton, J., Huang, R., Lee, Y., Christianson, A., Alvaro, C., Pena, J., Thomas, N., Canseco, J. A., Kurd, M. F., Kaye, I. D., Woods, B. I., Hilibrand, A. S., Vaccaro, A. R., Schroeder, G. D., & Kepler, C. K. (2026). Effect of Surgical Approach on Patient-reported Outcomes of Lumbar Fusion for Degenerative Spondylolisthesis: Should Grade Influence Approach?. Clinical spine surgery, 39(2), 54–59. https://doi.org/10.1097/BSD.0000000000001822

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40497577

Department(s)

Administration and Leadership

Document Type

Article