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Shaffer A, Yu AK, Yu A, Huesmann G, Iyer R, Arnold PM. One- and 2-year outcomes of lumbar facet arthroplasty versus spinal fusion in young (<65 years) and old (≥65 years) patients for the treatment of degenerative spondylolisthesis and stenosis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100329. [PMID: 38989291 PMCID: PMC11231454 DOI: 10.1016/j.xnsj.2024.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 07/12/2024]
Abstract
Background Facet arthroplasty, an alternative to lumbar fusion, offers stabilization and preserves range of motion. This subanalysis of the TOPS IDE trial (FDA #G160168) compared facet arthroplasty, using the TOPS device, with a standard single-level transforaminal lumbar interbody fusion (TLIF) in patients stratified by age (<65 and ≥65 years) with symptomatic grade 1 degenerative spondylolisthesis with moderate to severe spinal stenosis at L2-5. Methods Patient-reported outcomes (PROMS), including Oswestry disability index (ODI), visual analog pain scales (VAS), and Zurich claudication questionnaires (ZCQ), were assessed at baseline and multiple postoperative timepoints. Radiographic evaluation of flexion/extension range of motion (ROM) occurred at baseline, 12 months, and 24 months. Data were analyzed following an intention-to-treat model. Significance was defined as p<.05. Results About 299 patients were included (TOPS=206, TLIF=93). The groups were similar at baseline. At 2 years, the TOPS group had a greater proportion of patients report ≥15-point improvement for ODI (93.8% versus 77.1%, p=.011) and ≥20-point improvement for VAS back (84.4% versus 61.8%, p=.014). At 1 year, TOPS group had a greater proportion of patients report clinically significant improvements in all ZCQ categories (91.6% versus 78.5%, p=.012). In patients <65 years, the TOPS group had improved PROMS compared to TLIF at 2 years; however, these differences were less pronounced in patients ≥65 years old. The TOPS groups preserved more ROM at 12 (2.8° 95%CI [1.87; 3.74], p<.0001) and 24 (2.99° 95%CI [1.82; 4.15], p<.0001) months compared to TLIF. ROM was similarly preserved in patients aged <65 and ≥65. The rate of adverse events did not differ significantly between treatment groups. Conclusions Facet arthroplasty preserves more ROM in all ages and leads to improved PROMS compared to TLIF, particularly in younger patients.
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Affiliation(s)
- Annabelle Shaffer
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Alexander K. Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA 15212, United States
| | - Albert Yu
- Department of Statistics, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Graham Huesmann
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
- Department of Neurology, Carle Foundation Hospital, Urbana, IL 61801, United States
| | - Ravishanker Iyer
- Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Paul M. Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL 61801, United States
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Nassr A, Coric D, Pinter ZW, Sebastian AS, Freedman BA, Whiting D, Chahlavi A, Pirris S, Phan N, Meyer SA, Tahernia AD, Sandhu F, Deutsch H, Potts EA, Cheng J, Chi JH, Groff M, Anekstein Y, Steinmetz MP, Welch WC. Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1041-1053. [PMID: 38713762 DOI: 10.2106/jbjs.23.00719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND The comparative effectiveness of decompression plus lumbar facet arthroplasty versus decompression plus instrumented lumbar spinal fusion in patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis is unknown. METHODS In this randomized, controlled, Food and Drug Administration Investigational Device Exemption trial, we assigned patients who had single-level lumbar spinal stenosis and grade-I degenerative spondylolisthesis to undergo decompression plus lumbar facet arthroplasty (arthroplasty group) or decompression plus fusion (fusion group). The primary outcome was a predetermined composite clinical success score. Secondary outcomes included the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, Zurich Claudication Questionnaire (ZCQ), Short Form (SF)-12, radiographic parameters, surgical variables, and complications. RESULTS A total of 321 adult patients were randomized in a 2:1 fashion, with 219 patients assigned to undergo facet arthroplasty and 102 patients assigned to undergo fusion. Of these, 113 patients (51.6%) in the arthroplasty group and 47 (46.1%) in the fusion group who had either reached 24 months of postoperative follow-up or were deemed early clinical failures were included in the primary outcome analysis. The arthroplasty group had a higher proportion of patients who achieved composite clinical success than did the fusion group (73.5% versus 25.5%; p < 0.001), equating to a between-group difference of 47.9% (95% confidence interval, 33.0% to 62.8%). The arthroplasty group outperformed the fusion group in most patient-reported outcome measures (including the ODI, VAS back pain, and all ZCQ component scores) at 24 months postoperatively. There were no significant differences between groups in surgical variables or complications, except that the fusion group had a higher rate of developing symptomatic adjacent segment degeneration. CONCLUSIONS Among patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis, lumbar facet arthroplasty was associated with a higher rate of composite clinical success than fusion was at 24 months postoperatively. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Domagoj Coric
- Carolinas Neurosurgery & Spine Associates, SpineFirst Atrium Health, Charlotte, North Carolina
| | | | | | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Ali Chahlavi
- Ascension St. Vincent's Spine & Brain Institute, Jacksonville, Florida
- Mayo Clinic Florida, Jacksonville, Florida
| | - Stephen Pirris
- Ascension St. Vincent's Spine & Brain Institute, Jacksonville, Florida
- Mayo Clinic Florida, Jacksonville, Florida
| | | | - Scott A Meyer
- Atlantic Neurosurgical Specialists, Altair Health, Morristown, New Jersey
| | | | - Faheem Sandhu
- MedStar Georgetown University Hospital, Washington DC
| | | | - Eric A Potts
- Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | | | - John H Chi
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Yoram Anekstein
- Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
| | - Michael P Steinmetz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William C Welch
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Sattari SA, Xia Y, Azad TD, Caraway CA, Chang L. Advances in Implant Technologies for Spine Surgery. Neurosurg Clin N Am 2024; 35:217-227. [PMID: 38423737 DOI: 10.1016/j.nec.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Spine implants are becoming increasingly diversified. Taking inspiration from other industries, three-dimensional modeling of the spinal column has helped meet the custom needs of individual patients as both en bloc replacements and pedicle screw designs. Intraoperative tailoring of devices, a common need in the operating room, has led to expandable versions of cages and interbody spacers.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA
| | - Chad A Caraway
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Louis Chang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Pinter ZW, Freedman BA, Nassr A, Sebastian AS, Coric D, Welch WC, Steinmetz MP, Robbins SE, Ament J, Anand N, Arnold P, Baron E, Huang J, Whitmore R, Whiting D, Tahernia D, Sandhu F, Chahlavi A, Cheng J, Chi J, Pirris S, Groff M, Fabi A, Meyer S, Kushwaha V, Kent R, DeLuca S, Smorgick Y, Anekstein Y. A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis: Results from the Total Posterior Spine System (TOPS) IDE Study. Clin Spine Surg 2023; 36:E59-E69. [PMID: 36191093 PMCID: PMC9949521 DOI: 10.1097/bsd.0000000000001365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective randomized Food and Drug Administration investigational device exemption clinical trial. OBJECTIVE The purpose of the present study is to report the 1-year clinical and radiographic outcomes and safety profile of patients who underwent lumbar facet arthroplasty through implantation of the Total Posterior Spine System (TOPS) device. SUMMARY OF BACKGROUND DATA Lumbar facet arthroplasty is one proposed method of dynamic stabilization to treat grade-1 spondylolisthesis with stenosis; however, there are currently no Food and Drug Administration-approved devices for facet arthroplasty. METHODS Standard demographic information was collected for each patient. Radiographic parameters and patient-reported outcome measures were assessed preoperatively and at regular postoperative intervals. Complication and reoperation data were also collected for each patient. RESULTS At the time of this study, 153 patients had undergone implantation of the TOPS device. The mean surgical time was 187.8 minutes and the mean estimated blood loss was 205.7cc. The mean length of hospital stay was 3.0 days. Mean Oswestry Disability Index, Visual Analog Score leg and back, and Zurich Claudication Questionnaire scores improved significantly at all postoperative time points ( P >0.001). There were no clinically significant changes in radiographic parameters, and all operative segments remained mobile at 1-year follow-up. Postoperative complications occurred in 11 patients out of the 153 patients (7.2%) who underwent implantation of the TOPS device. Nine patients (5.9%) underwent a total of 13 reoperations, 1 (0.6%) of which was for device-related failure owing to bilateral L5 pedicle screw loosening. CONCLUSIONS Lumbar facet arthroplasty with the TOPS device demonstrated a statistically significant improvement in all patient-reported outcome measures and the ability to maintain motion at the index level while limiting sagittal translation with a low complication rate.
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Affiliation(s)
| | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Domagoj Coric
- Carolinas Neurosurgery & Spine Associates, Charlotte, NC
| | - William C. Welch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Neel Anand
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Eli Baron
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | - Faheem Sandhu
- MedStar Georgetown University Hospital, District of Columbia, WA
| | - Ali Chahlavi
- Ascension St. Vincent’s Southside, Jacksonville, FL
| | | | - John Chi
- Brigham and Women’s Hospital, Boston, MA
| | | | | | - Alain Fabi
- Bronson Methodist Hospital, Kalamazoo, MI
| | | | | | | | - Steven DeLuca
- Orthopedic Institute of Pennsylvania, Harrisburg, PA
| | - Yossi Smorgick
- Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
| | - Yoram Anekstein
- Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
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Coric D, Nassr A, Kim PK, Welch WC, Robbins S, DeLuca S, Whiting D, Chahlavi A, Pirris SM, Groff MW, Chi JH, Huang JH, Kent R, Whitmore RG, Meyer SA, Arnold PM, Patel AI, Orr RD, Krishnaney A, Boltes P, Anekstein Y, Steinmetz MP. Prospective, randomized controlled multicenter study of posterior lumbar facet arthroplasty for the treatment of spondylolisthesis. J Neurosurg Spine 2023; 38:115-125. [PMID: 36152329 DOI: 10.3171/2022.7.spine22536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of a posterior facet replacement device, the Total Posterior Spine (TOPS) System, for the treatment of one-level symptomatic lumbar stenosis with grade I degenerative spondylolisthesis. Posterior lumbar arthroplasty with facet replacement is a motion-preserving alternative to lumbar decompression and fusion. The authors report the preliminary results from the TOPS FDA investigational device exemption (IDE) trial. METHODS The study was a prospective, randomized controlled FDA IDE trial comparing the investigational TOPS device with transforaminal lumbar interbody fusion (TLIF) and pedicle screw fixation. The minimum follow-up duration was 24 months. Validated patient-reported outcome measures included the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. The primary outcome was a composite measure of clinical success: 1) no reoperations, 2) no device breakage, 3) ODI reduction of ≥ 15 points, and 4) no new or worsening neurological deficit. Patients were considered a clinical success only if they met all four measures. Radiographic assessments were made by an independent core laboratory. RESULTS A total of 249 patients were evaluated (n = 170 in the TOPS group and n = 79 in the TLIF group). There were no statistically significant differences between implanted levels (L4-5: TOPS, 95% and TLIF, 95%) or blood loss. The overall composite measure for clinical success was statistically significantly higher in the TOPS group (85%) compared with the TLIF group (64%) (p = 0.0138). The percentage of patients reporting a minimum 15-point improvement in ODI showed a statistically significant difference (p = 0.037) favoring TOPS (93%) over TLIF (81%). There was no statistically significant difference between groups in the percentage of patients reporting a minimum 20-point improvement on VAS back pain (TOPS, 87%; TLIF, 64%) and leg pain (TOPS, 90%; TLIF, 88%) scores. The rate of surgical reintervention for facet replacement in the TOPS group (5.9%) was lower than the TLIF group (8.8%). The TOPS cohort demonstrated maintenance of flexion/extension range of motion from preoperatively (3.85°) to 24 months (3.86°). CONCLUSIONS This study demonstrates that posterior lumbar decompression and dynamic stabilization with the TOPS device is safe and efficacious in the treatment of lumbar stenosis with degenerative spondylolisthesis. Additionally, decompression and dynamic stabilization with the TOPS device maintains segmental motion.
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Affiliation(s)
- Domagoj Coric
- 1Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- 2Department of Neurosurgery, SpineFirst, Atrium Health, Charlotte, North Carolina
| | - Ahmad Nassr
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Paul K Kim
- 1Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- 2Department of Neurosurgery, SpineFirst, Atrium Health, Charlotte, North Carolina
| | - William C Welch
- 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Steven DeLuca
- 6Orthopedic Institute of Pennsylvania, Harrisburg, Pennsylvania
| | - Donald Whiting
- 7Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ali Chahlavi
- 8Department of Neurosurgery, Ascension St. Vincent, Jacksonville, Florida
| | - Stephen M Pirris
- 8Department of Neurosurgery, Ascension St. Vincent, Jacksonville, Florida
| | - Michael W Groff
- 9Department of Neurosurgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - John H Chi
- 9Department of Neurosurgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Jason H Huang
- 10Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas
| | | | - Robert G Whitmore
- 12Department of Neurosurgery, Lahey Medical Center, Burlington, Massachusetts
| | - Scott A Meyer
- 13Department of Neurosurgery, Altair Health Spine, Morristown, New Jersey
| | | | | | - R Douglas Orr
- 16Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio; and
| | - Ajit Krishnaney
- 16Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio; and
| | - Peggy Boltes
- 1Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- 2Department of Neurosurgery, SpineFirst, Atrium Health, Charlotte, North Carolina
| | - Yoram Anekstein
- 17Department of Orthopaedics, Sackler School of Medical of Medicine, Tel Aviv, Israel
| | - Michael P Steinmetz
- 16Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio; and
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6
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Ambrosio L, Vadalà G, Russo F, Pascarella G, De Salvatore S, Papalia GF, Ruggiero A, Di Folco M, Carassiti M, Papalia R, Denaro V. Interventional Minimally Invasive Treatments for Chronic Low Back Pain Caused by Lumbar Facet Joint Syndrome: A Systematic Review. Global Spine J 2022; 13:1163-1179. [PMID: 36458366 DOI: 10.1177/21925682221142264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To investigate the efficacy of nonsurgical interventional treatments for chronic low back pain (LBP) caused by facet joint syndrome (FJS). METHODS A systematic review of the literature was conducted to identify studies that compared interventional treatments for LBP due to FJS among them, with usual care or sham procedures. Studies were evaluated for pain, physical function, disability, quality of life and employment status. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. RESULTS Eighteen studies published between January 2000 and December 2021 were included (1496 patients, mean age: 54.31 years old). Intraarticular (IA) facet joint (FJ) injection of hyaluronic acid (HA) did not show significant difference compared to IA corticosteroids (CCS) in terms of pain and satisfaction. FJ denervation using radiofrequency (RF) displayed slightly superior or similar outcomes compared to IA CCS, physical therapy, or sham procedure. IA CCS showed better outcomes when combined with oral diclofenac compared to IA CCS or oral diclofenac alone but was not superior to IA local anesthetic and Sarapin. IA platelet-rich plasma (PRP) led to an improvement of pain, disability and satisfaction in the long term compared to IA CCS. CONCLUSION FJS is a common cause of LBP that can be managed with several different strategies, including nonsurgical minimally invasive approaches such as IA HA, CCS, PRP and FJ denervation. However, available evidence showed mixed results, with overall little short-term or no benefits on pain, disability, and other investigated outcomes.
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Affiliation(s)
- Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Pascarella
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Sergio De Salvatore
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe F Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Ruggiero
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Marta Di Folco
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, 9317Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, 9317Università Campus Bio-Medico di Roma, Rome, Italy
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Jamshidi AM, Soldozy S, Levi AD. Efficacy of Reverse and Modified Bohlman Technique for Lumbar Spondylolisthesis: A Systematic Review of the Literature. World Neurosurg 2021; 162:36-41. [PMID: 34871805 DOI: 10.1016/j.wneu.2021.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Aria M Jamshidi
- University of Miami MILLER School of Medicine, Department of Neurological Surgery Lois Pope Life Center 1095 NW 14 (th) Terrace (D4-6), Miami, FL 33136
| | - Sauson Soldozy
- University of Miami MILLER School of Medicine, Department of Neurological Surgery Lois Pope Life Center 1095 NW 14 (th) Terrace (D4-6), Miami, FL 33136
| | - Alan D Levi
- University of Miami MILLER School of Medicine, Department of Neurological Surgery, 1095 Northwest 14th Terrace, Suite (D4-6), Miami, FL 33136
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