Reverse Bohlman technique for treatment of high-grade spondylolisthesis in an adult population

Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review

Degenerative spine disorders are very common in the aging population. Degenerative spondylolisthesis is a relatively uncommon cause of chronic back pain in these patients. We present a case of high-grade spondylolisthesis managed with posterior lumbar interbody fusion (PLIF) and reduction of the listhesis with excellent results. A 56-year-old woman presented with chronic lower back pain managed as an outpatient for over 5 months with no relief. She had no history of trauma or risk factors for malignancy. Lumbosacral CT showed Meyerding grade 3 anterolisthesis of the fifth lumbar vertebra with complete L5-S1 disc collapse and bilateral spondylolysis. An MRI confirmed the findings. There was no spinal canal stenosis. The patient was managed with L4-L5-S1 transpedicular fixation and L5-S1 interbody cage with reduction of the listhesis. The patient had an incidental intraoperative dural tear which was repaired primarily and a wound drain was kept for 5 days without complications. The patient was ambulating by day 5 and was discharged without complications on day 10. Degenerative spondylolisthesis can cause chronic back pain with or without a history of trauma. Although no specific clinical features exist for this condition, it should be suspected in elderly patients even in the absence of a history of trauma. Surgical management in high-grade spondylolisthesis is indicated with interbody fixation and reduction. 

Efficacy of Reverse and Modified Bohlman Technique for Lumbar Spondylolisthesis: A Systematic Review of the Literature

OBJECTIVE

High grade lumbar spondylolisthesis (HGLS) remains a challenging surgical entity, and there is no current consensus regarding optimal surgical approach. The purpose of this study was to systematically review the literature for studies utilizing the Reverse or Modified Bohlman technique for the treatment of HGLS to assess its safety and efficacy.

METHODS

The authors perform a literature search of PubMed/MEDLINE electronic databases from their inception according to the PRISMA guidelines.

RESULTS

A total of 8 studies were included. The studies comprised a total of 43 patients, with mean age of 41.4 ± 19.8 (9-83) years. The mean follow-up was 38.2 ± 41.7 (3-137) months. Most patients (81.4%) were classified as having grade III or higher spondylolisthesis. The most common presenting symptom was back pain (93%), followed by radiculopathy in roughly half of patients (41.9%). Majority of patients (93%) experienced complete resolution of symptoms as well as successful fusion (90.7%) on follow-up. Complications included cage/graft failure (7%), nerve injury (7%), wound infection (7%), pseudoarthrosis (2.3%), epidural hematoma (2.3%), and deep vein thrombosis (2.3%). Revision surgery was required in 4 (9.3%) patients. Slip percentage (60.2% versus 43.2%, p<0.0001) and slip angle (17.1° versus 6.4°, p<0.001) both decreased significantly following surgery.

CONCLUSIONS

Our data demonstrate Reverse and Modified Bohlman techniques appear to be effective in both improving slip angle/percentage and relieving symptoms with low risk of complications. These findings are limited by the small sample size of patients. The authors recommend larger series before formal recommendations can be made.