Development and validation of a novel classification for characterizing degenerative spondylolisthesis of lumbar spine.

To performed classification based on global alignment and segmental balance, to better characterize single-segment Meyerding Grade I degenerative spondylolisthesis of lumbar spine (DSLS). A multicenter retrospective cohort study was performed, where 278 and 92 DSLS composed derivation and validation cohorts. Radiographical parameters contained lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA) and inflected and apical vertebrae. The quality-of life scales contained visual analog scales of low back pain (VAS-LBP) and leg pain (VAS-LP) and Oswestry Disability Index (ODI). The classification system was based on global alignment type and PI-LL: Type 1 and 2 with PI < 50°, while inflection < L2 in Type 1, Type 3 and 4 with PI ≥ 50°, while SS < 45° in Type 3; Subtype 2 A and 3 A with ideal PI-LL while 2B and 3B with unideal PI-LL. In derivation cohort, all DSLS acquired reduction and quality-of-life scales improved. At baseline, ODI and VAS-LBP was the highest in type 4, higher than type 3 and 1 (P = 0.030 and P = 0.041) but not for VAS-LP. In PI-LL subtype, ODI was worse in PI-LL mismatch subgroup in type 2 and 3 and VAS-LBP was worse in PI-LL mismatch subgroup in type 3 compared to match subgroup. All quality-of life scales were comparable among types. In validation cohort, there was 2 A-2B and 3 A-3B difference on ODI but comparable after surgery. The DSLS classification based on global shape (type 1-4) and PI-LL (A and B) was developed, where type 4 was linked to poor quality-of-life. This process broaden comprehensive analysis for DSLS.