High-grade spondylolisthesis treated using a modified Bohlman technique: Results among multiple surgeons: Clinical article

Robert Hart, Christopher M. Domes, Brady Goodwin, Charles R. D'Amato, Jung Yoo, Ronald J. Turker, Matthew F. Halsey

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)523-530
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume20
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Spondylolisthesis
Reoperation
Spine
Transplants
Fracture Fixation
Kyphosis
Radiculopathy
Debridement
Surgeons
Titanium
Venous Thrombosis
Hematoma
Infection

Keywords

  • Allograft
  • Complications
  • Lumbar spine
  • Spine fusion
  • Spondylolisthesis
  • Technique

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

High-grade spondylolisthesis treated using a modified Bohlman technique : Results among multiple surgeons: Clinical article. / Hart, Robert; Domes, Christopher M.; Goodwin, Brady; D'Amato, Charles R.; Yoo, Jung; Turker, Ronald J.; Halsey, Matthew F.

In: Journal of Neurosurgery: Spine, Vol. 20, No. 5, 2014, p. 523-530.

Research output: Contribution to journalArticle

Hart, Robert ; Domes, Christopher M. ; Goodwin, Brady ; D'Amato, Charles R. ; Yoo, Jung ; Turker, Ronald J. ; Halsey, Matthew F. / High-grade spondylolisthesis treated using a modified Bohlman technique : Results among multiple surgeons: Clinical article. In: Journal of Neurosurgery: Spine. 2014 ; Vol. 20, No. 5. pp. 523-530.
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abstract = "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.",
keywords = "Allograft, Complications, Lumbar spine, Spine fusion, Spondylolisthesis, Technique",
author = "Robert Hart and Domes, {Christopher M.} and Brady Goodwin and D'Amato, {Charles R.} and Jung Yoo and Turker, {Ronald J.} and Halsey, {Matthew F.}",
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AU - Hart, Robert

AU - Domes, Christopher M.

AU - Goodwin, Brady

AU - D'Amato, Charles R.

AU - Yoo, Jung

AU - Turker, Ronald J.

AU - Halsey, Matthew F.

PY - 2014

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N2 - 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.

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KW - Allograft

KW - Complications

KW - Lumbar spine

KW - Spine fusion

KW - Spondylolisthesis

KW - Technique

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