Does Adherence to Treatment Guidelines from the Ghailane-Gille Classification for Degenerative Spondylolisthesis of the Lumbar Spine Impact Surgical Outcomes? A Match-Mismatch Study

Abstract

Background/Objectives: satisfactory sagittal alignment when treating degenerative spondylolisthesis of the lumbar spine (DSLS) may produce better clinical and radiographic outcomes compared to treatment focused solely on isolated segments when indicated. Ghailane et al. proposed a treatment guideline based on their classification system. The aim of this study was to investigate the impact of adherence to Ghailane-Gille (GG) treatment guidelines on surgical outcomes in patients with DSLS. Methods: A monocentric retrospective cohort analysis was performed from 2021 to September 2024. Data were collected from patients treated for DSLS, covering the period from baseline to one-year follow-up. Patients were divided into two groups based on GG treatment guidelines: the "Match group" (patients who underwent surgery following GG guidelines) and the "Mismatch group" (patients who did not adhere to these guidelines). Preoperative and postoperative clinical outcomes, patient satisfaction, and operative parameters were collected and compared between groups. Results: A total of 80 patients were enrolled, with 52 in the Match group and 28 in the Mismatch group. At baseline, the Oswestry Disability Index (ODI) score demonstrated significant variation among classification subtypes and a positive correlation. The Match group exhibited a significant reduction in ODI scores one year postoperatively and maintained high levels of satisfaction; no significant intraoperative differences were noted. Additionally, patients in the Mismatch group were more frequently classified as American Society of Anesthesiologists (ASA) III compared to the Match group (70% vs. 30%), suggesting clinicians' hesitance to fully implement GG guidelines in aggressive treatment strategies for those patients. Conclusions: Adhering to the GG treatment guidelines for restoring sagittal alignment in DSLS patients is associated with decreased ODI scores regardless of age, ensuring patient satisfaction at one-year follow-up. This approach could potentially benefit ASA III patients as well.

Keywords: ASA; degenerative spondylolisthesis of the lumbar spine; sagittal alignment.

Figure 1

Figure introduction. Abbreviations: SVA; Sagittal Vertical Axis; PI; pelvic incidence; LL: lumbar lordosis.

Figure 2

Preoperative ODI score distribution following GG classification subtypes. Overall, there were 80 DSLS patients subdivided in three types (Type 3 in red plot; n = 23—Type 2 in orange plot: n = 10; and Type 1 in green plot: n = 47) of preoperative ODI distribution (A) and correlation (B) are represented. (ns) correspond to not significant and (**) to p < 0.01.

Figure 3

Preoperative ASA score distribution within postoperative MATCH or MISMATCH groups. All DSLS patients (A), preoperative subtypes (B), ASA score distribution and relationship between preoperative ASA score on post-operative matching versus mismatching groups (C).