Evaluating Instability in Degenerative Lumbar Spondylolisthesis: Objective Variables Versus Surgeon Impressions

Mark A. Maclean, Chris Bailey, Charles Fisher, Yoga Raja Rampersaud, Ryan Greene, Edward Abraham, Nicholas Dea, Hamilton Hall, Neil Manson, Raymond Andrew Glennie

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Background:The subjective degenerative spondylolisthesis instability classification (S-DSIC) system attempts to define preoperative instability associated with degenerative lumbar spondylolisthesis (DLS). The system guides surgical decision-making based on numerous indicators of instability that surgeons subjectively assess and incorporate. A more objective classification is warranted in order to decrease variation among surgeons. In this study, our objectives included (1) proposing an objective version of the DSIC system (O-DSIC) based on the best available clinical and biomechanical data and (2) comparing subjective surgeon perceptions (S-DSIC) with an objective measure (O-DSIC) of instability related to DLS.Methods:In this multicenter cohort study, we prospectively enrolled 408 consecutive adult patients who received surgery for symptomatic DLS. Surgeons prospectively categorized preoperative instability using the existing S-DSIC system. Subsequently, an O-DSIC system was created. Variables selected for inclusion were assigned point values based on previously determined evidence quality. DSIC types were derived by point summation: 0 to 2 points was considered stable, Type I); 3 points, potentially unstable, Type II; and 4 to 5 points, unstable, Type III. Surgeons' subjective perceptions of instability (S-DSIC) were retrospectively compared with O-DSIC types.Results:The O-DSIC system includes 5 variables: presence of facet effusion, disc height preservation (≥6.5 mm), translation (≥4 mm), a kyphotic or neutral disc angle in flexion, and low back pain (≥5 of 10 intensity). Type I (n = 176, 57.0%) and Type II (n = 164, 53.0%) were the most common DSIC types according to the O-DSIC and S-DSIC systems, respectively. Surgeons categorized higher degrees of instability with the S-DSIC than the O-DSIC system in 130 patients (42%) (p < 0.001). The assignment of DSIC types was not influenced by demographic variables with either system.Conclusions:The O-DSIC system facilitates objective assessment of preoperative instability related to DLS. Surgeons assigned higher degrees of instability with the S-DSIC than the O-DSIC system in 42% of cases.Level of Evidence:Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Article numbere22.00052
JournalJBJS Open Access
Volume7
Issue number4
DOIs
Publication statusPublished - Nov 21 2022

Bibliographical note

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© 2022 JBJS Open Access. All right reserved.

ASJC Scopus Subject Areas

  • Surgery
  • Orthopedics and Sports Medicine

PubMed: MeSH publication types

  • Journal Article

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