Effect of Clinical and Radiographic Degenerative Spondylolisthesis Classification on Patient-reported Outcomes and Spinopelvic Parameters for Patients With Single-level L4-L5 Degenerative Spondylolisthesis After Lumbar Fusion.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine whether preoperative clinical and radiographic degenerative spondylolisthesis (CARDS) classification is associated with differences in patient-reported outcomes and spinopelvic parameters after posterior decompression and fusion for L4-L5 degenerative spondylolisthesis (DS). SUMMARY: The CARDS classification for lumbar DS, an alternative to the Meyerding system, considers additional radiographic findings such as disc space collapse and segmental kyphosis and stratifies DS into 4 radiographically distinct classes. Although CARDS has been shown to be a reliable and reproducible method for classifying DS, very few studies have assessed whether the CARDS types represent distinct clinical entities. PATIENTS AND METHODS: A retrospective cohort analysis was conducted on patients with L4-L5 DS who underwent posterior lumbar decompression and fusion. Changes in spinopelvic alignment and patient-reported outcomes measures, including recovery ratios and percentage of patients achieving the minimal clinically important difference, were compared among patients in each CARDS classification 1-year postoperatively using analysis of variance or Kruskal-Wallis H with Dunn post hoc analysis. Multiple linear regression determined whether CARDS groups significantly predicted patient-reported outcomes measures, lumbar lordosis (LL), and pelvic incidence-lumbar lordosis mismatch (PI-LL) while controlling for demographic and surgical characteristics. RESULTS: Preoperative type B spondylolisthesis predicted decreased improvement in "physical component and mental component score of the short form-12" compared with type A spondylolisthesis (ß-coefficient = -5.96, P = 0.031) at 1 year. Significant differences were found between CARDS groups with regards to ΔLL (A: -1.63 degrees vs B: -1.17 degrees vs C: 2.88 degrees vs D: 3.19 degrees, P = 0.010) and ΔPI-LL (A: 1.02 degrees vs B: 2.09 degrees vs C: -2.59 degrees vs D: -3.70 degrees, P = 0.012). Preoperative type C spondylolisthesis was found to predict increased LL (ß-coefficient = 4.46, P = 0.0054) and decreased PI-LL (ß-coefficient = -3.49, P = 0.025) at 1 year compared with type A spondylolisthesis. CONCLUSIONS: Clinical and radiographic outcomes differed significantly by preoperative CARDS classification type for patients undergoing posterior decompression and fusion for L4-L5 DS. LEVEL OF EVIDENCE: Level III.

Leveraging Telehealth: Utilizing Digital Health Technology to Improve Patient Care in Orthopaedics.

The past decade has seen a shift in health care delivery models to be more value-based: patient-centered, accessible, and cost-effective. One of the primary modes of addressing these needs has been through the implementation of telemedicine-digital health care technology that streamlines and enhances traditional health care delivery. In the orthopaedic setting, there are various methods of telemedicine utilization, each uniquely optimized for different clinical scenarios. There are certain financial and technological limitations when utilizing telemedicine for orthopaedic care that pose notable barriers to uniform utilization across the specialty. Nonetheless, these challenges are currently being tested as orthopaedic surgeons continuously become more innovative and creative as to how they deliver care. As we enter our "new normal" in the post-COVID-19 era, the availability and use of telemedicine will equip orthopaedic surgeons to deliver high-quality, affordable, and accessible care in an ever-changing health care landscape.