Reverse Bohlman technique for treatment of high-grade spondylolisthesis in an adult population. (November 2019)

• Record Type: Journal Article
• Authors: Jamshidi, Aria; Levi, Allan D.
• Is Part Of: Journal of clinical neuroscience. Volume 69(2019)
• Page Start: 230
• Page End: 236
• Publication Date: 2019-11
• Subjects: Bohlman -- Reverse -- High grade -- Spondylolisthesis; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.07.044
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Surgical techniques for treatment of high-grade spondylolisthesis remain controversial. The reverse Bohlman approach represents a novel approach for the treatment of high-grade spondylolisthesis. Mean pre-operative anterolisthesis improved from 18.3% to 10.1%. Slip angle improved from 60.43° to 48.71°. First study comparing outcomes of modified Bohlman and reverse Bohlman procedure. Abstract: Background/aims: Surgical techniques for treatment of high-grade spondylolisthesis (HGS) remain controversial. This study aims to evaluate both radiographic and clinical outcomes in patients with HGS treated with the "modified Bohlman" and Reverse Bohlman technique. Methods: Review of consecutive HGS patients undergoing modified Bohlman and Reverse Bohlman at a single center from 2006 to 2018. Clinical, surgical, and radiographic data were collected. Results: Six patients identified in the modified Bohlman treatment arm: and eight patients in the Reverse Bohlman group. Twelve (12) patients presented with high grade congenital spondylolisthesis at L5-S1; one patient presented with dissolution of the L5 vertebral body secondary to uncontrolled osteomyelitis that developed after a previous failed fusion; and one patient presented with iatrogenic L5-S1 spondylolisthesis after a previous L3-S1 fusion. One patient had medially placement pedicle screw and associated radiculopathy. All follow-up post = operative scans demonstrated solid fusion. Postoperatively, anterolisthesis improved from 18.3% to 10.1% (p = .0586) and the slip angle improved from 60.43° of kyphosis to 48.71° (p = .0139). No spondylolisthesis translational reduction maneuvers were attempted intraoperatively except for positioning on a sacral cushion to increase lordotic angle. Lumbar lordosis improved from 65.29 to 63.86 postoperatively. Four of our fourteen patients had long-term median follow-up of 28 months (range = 19–48 months) slip angle, percentage, and lumbar lordosis all improved from the patient's pre-operative measurements. The improvement in slip angle was nearly statistically significant with a p-value of 0.065. Conclusions: Reverse Bohlman technique for high grade spondylolisthesis is a viable option when seeking to address adjacent level instability or slip.