High-grade spondylolisthesis treated using a modified Bohlman technique: results among multiple surgeons

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  • 1 Orthopaedic Surgery, Oregon Health & Science University, Portland;
  • 3 Orthopaedic Surgery, Shriners Hospitals for Children, Portland;
  • 4 Orthopaedic Surgery, Kaiser Permanente, Portland, Oregon; and
  • 2 Orthopaedic Surgery, University of Washington, Seattle, Washington
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Object

The ideal surgical management of high-grade spondylolisthesis remains unclear. Concerns regarding the original Bohlman transsacral interbody fusion technique with stand-alone autologous fibular strut include late graft fracture and incomplete reduction of lumbosacral kyphosis. The authors' goal was to evaluate the radiographic and surgical outcomes of patients treated for high-grade spondylolisthesis with either transsacral S-1 screws or standard pedicle screw fixation augmenting the Bohlman posterior transsacral interbody fusion technique.

Methods

A retrospective review of patients who underwent fusion for high-grade spondylolisthesis in which a Bohlman oblique posterior interbody fusion augmented with either transsacral or standard pedicle screw fixation was performed by 4 spine surgeons was completed. Estimated blood loss, operating time, perioperative complications, and need for revision surgery were evaluated. Upright pre- and postsurgical lumbar spine radiographs were compared for slip percent and slip angle.

Results

Sixteen patients (12 female and 4 male) with an average age of 29 years (range 9–66 years) were evaluated. The average clinical follow-up was 78 months (range 5–137 months) and the average radiographic follow-up was 48 months (range 5–108 months). Ten L4–S1 and 6 L5–S1 fusions were performed. Five fibular struts and 11 titanium mesh cages were used for interbody fusion. Six patients had isolated transsacral screws placed, with 2 (33%) of the 6 requiring revision surgery for nonunion. No nonunions were observed in patients undergoing spanning pedicle screw fixation augmenting the interbody graft. Six patients experienced perioperative complications including 3 iliac crest site infections, 1 L-5 radiculopathy without motor involvement, 1 deep vein thrombosis, and 1 epidural hematoma requiring irrigation and debridement. The average estimated blood loss and operating times were 763 ml and 360 minutes, respectively. Slip percent improved from an average of 62% to 37% (n = 16; p < 0.01) and slip angle improved from an average of 18° to 8° (n = 16; p < 0.01). No patient experienced L-5 or other motor deficit postoperatively.

Conclusions

The modified Bohlman technique for treatment of high-grade spondylolisthesis has reproducible outcomes among multiple surgeons and results in significant improvements in slip percent and slip angle. Fusion rates were high (14 of 16; 88%), especially with spanning instrumentation augmenting the oblique interbody fusion. Rates of L-5 motor deficit were low in comparison with techniques involving reduction of the anterolisthesis.

Abbreviations used in this paper:AP = anteroposterior; BMP-2 = bone morphogenetic protein–2; EBL = estimated blood loss; MCS = mental component summary; ODI = Oswestry Disability Index; PCS = physical component summary; SF-12 = Short Form-12 Health Survey.

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Contributor Notes

Address correspondence to: Robert A. Hart, M.D., M.A., Orthopaedic Surgery, Oregon Health & Science University, Sam Jackson Hall, Ste. 2360, 3181 SW Sam Jackson Park Rd., Portland, OR 97239. email: hartro@ohsu.edu.

Please include this information when citing this paper: published online February 21, 2014; DOI: 10.3171/2014.1.SPINE12904.

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