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Abstract：
OBJECTIVE: Clinical and radiographic degenerative spondylolisthesis (CARDS) classification was proposed to differentiate homogenous lumbar degenerative spondylolisthesis (LDS) subgroups. The sitting radiograph exhibited lumbar malalignment with maximum lumbar kyphosis, intervertebral kyphosis, and spondylolisthesis.This study aimed to assess the sitting radiograph for distribution of clinical and radiographic degenerative spondylolisthesis classification, and to elucidate its significance for exhibiting kyphotic alignment (CARDS type D) and segmental instability.
METHODS: A cohort of 101 patients with symptomatic lumbar degenerative spondylolisthesis (LDS) between September 2018 and December 2020 were recruited. The distribution and relibility of CARDS classification with or without sitting radiograph was assessed. The translational and angular range of motion and segmental instability was also evaluated. Univariate analysis of variance was used for multiple groups, and the least significant difference for two groups. Kappa consistency test of intrarater and interrater was evaluated for CARDS classification with or without sitting radiograph. Chi-square test was used to compare paried categorical data.
RESULTS: Utility of sitting radiographs for CARDS classification revealed higher percentage of type D than that without the sitting radiograph (p < 0.001). The sitting radiograph revealed a larger slip distance than the flexion radiograph (p = 0.003), as well as a lower slip angle than flexion radiograph (p < 0.001). The sitting-supine modality demonstrated the largest translational range of motion compared to the sitting-extension (p < 0.001) and flexion-extension modalities (p < 0.001). The sitting-supine modality showed larger angular range of motion than the flexion-extension modality (p < 0.001). The percentage of flexion, extension, upright, supine, and sitting radiograph to identify translational instability was higher than that without sitting radiograph (p < 0.001), as well as taking angular motion ≥10° as an additional criterion for segmental instability (p < 0.001).
CONCLUSIONS: The CARDS classification was reliable for LDS. The sitting radiograph showed maximal slip distance and kyphotic slip angle. Application of the sitting radiograph was necessary for evaluating segmental instability and kyphotic alignment of LDS.
METHODS: A cohort of 101 patients with symptomatic lumbar degenerative spondylolisthesis (LDS) between September 2018 and December 2020 were recruited. The distribution and relibility of CARDS classification with or without sitting radiograph was assessed. The translational and angular range of motion and segmental instability was also evaluated. Univariate analysis of variance was used for multiple groups, and the least significant difference for two groups. Kappa consistency test of intrarater and interrater was evaluated for CARDS classification with or without sitting radiograph. Chi-square test was used to compare paried categorical data.
RESULTS: Utility of sitting radiographs for CARDS classification revealed higher percentage of type D than that without the sitting radiograph (p < 0.001). The sitting radiograph revealed a larger slip distance than the flexion radiograph (p = 0.003), as well as a lower slip angle than flexion radiograph (p < 0.001). The sitting-supine modality demonstrated the largest translational range of motion compared to the sitting-extension (p < 0.001) and flexion-extension modalities (p < 0.001). The sitting-supine modality showed larger angular range of motion than the flexion-extension modality (p < 0.001). The percentage of flexion, extension, upright, supine, and sitting radiograph to identify translational instability was higher than that without sitting radiograph (p < 0.001), as well as taking angular motion ≥10° as an additional criterion for segmental instability (p < 0.001).
CONCLUSIONS: The CARDS classification was reliable for LDS. The sitting radiograph showed maximal slip distance and kyphotic slip angle. Application of the sitting radiograph was necessary for evaluating segmental instability and kyphotic alignment of LDS.
摘要：
目的：提出了临床和影像学退行性腰椎滑脱（CARDS）分类以区分同质腰椎退行性滑脱（LDS）亚组。坐位X线片显示腰椎错位，最大腰椎后凸，椎间后凸畸形,和脊椎前移.本研究旨在评估坐位X线片的临床和影像学退行性腰椎滑脱分类分布，并阐明其表现后凸排列（CARDSD型）和节段不稳定的意义。
方法：招募了一个队列，包括2018年9月至2020年12月的101例症状性腰椎退行性滑脱（LDS）患者。评估有或没有坐位X光片的CARDS分类的分布和可靠性。还评估了运动的平移和角度范围以及节段不稳定性。对多组使用单变量方差分析，两组差异最小。评估内部和中间的Kappa一致性测试，以评估有无坐位X光片的CARDS分类。采用卡方检验比较同类数据。
结果：用于卡片分类的坐位X光片显示D型的百分比高于没有坐位X光片的百分比（p<0.001）。坐位射线照片显示滑动距离大于屈曲射线照片（p=0.003），以及较低的滑移角比屈曲X光片（p<0.001）。坐姿-仰卧方式显示出最大的平移运动范围，与坐姿-伸展方式（p<0.001）和屈伸方式（p<0.001）相比。坐姿-仰卧模式显示出比屈伸模式更大的运动角度范围（p<0.001）。屈曲的百分比，扩展,直立,仰卧,坐位X光片识别平移不稳定性高于没有坐位X光片（p<0.001），以及将角运动≥10°作为节段不稳定性的附加标准（p<0.001）。
结论：LDS的CARDS分类是可靠的。坐位X光片显示最大滑移距离和后倾角。坐位X线片的应用对于评估LDS的节段不稳定性和后凸排列是必要的。
方法：招募了一个队列，包括2018年9月至2020年12月的101例症状性腰椎退行性滑脱（LDS）患者。评估有或没有坐位X光片的CARDS分类的分布和可靠性。还评估了运动的平移和角度范围以及节段不稳定性。对多组使用单变量方差分析，两组差异最小。评估内部和中间的Kappa一致性测试，以评估有无坐位X光片的CARDS分类。采用卡方检验比较同类数据。
结果：用于卡片分类的坐位X光片显示D型的百分比高于没有坐位X光片的百分比（p<0.001）。坐位射线照片显示滑动距离大于屈曲射线照片（p=0.003），以及较低的滑移角比屈曲X光片（p<0.001）。坐姿-仰卧方式显示出最大的平移运动范围，与坐姿-伸展方式（p<0.001）和屈伸方式（p<0.001）相比。坐姿-仰卧模式显示出比屈伸模式更大的运动角度范围（p<0.001）。屈曲的百分比，扩展,直立,仰卧,坐位X光片识别平移不稳定性高于没有坐位X光片（p<0.001），以及将角运动≥10°作为节段不稳定性的附加标准（p<0.001）。
结论：LDS的CARDS分类是可靠的。坐位X光片显示最大滑移距离和后倾角。坐位X线片的应用对于评估LDS的节段不稳定性和后凸排列是必要的。
