Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
J Clin Neurosci. 2019 Nov;69:230-236. doi: 10.1016/j.jocn.2019.07.044. Epub 2019 Aug 19.
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.
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.
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.
Reverse Bohlman technique for high grade spondylolisthesis is a viable option when seeking to address adjacent level instability or slip.
背景/目的：治疗高度脊椎滑脱（HGS）的手术技术仍存在争议。本研究旨在评估“改良 Bohlman”和反向 Bohlman 技术治疗 HGS 患者的影像学和临床结果。
回顾 2006 年至 2018 年在单中心接受改良 Bohlman 和反向 Bohlman 治疗的连续 HGS 患者。收集临床、手术和影像学数据。
改良 Bohlman 治疗组发现 6 例患者，反向 Bohlman 组 8 例患者。12 例患者表现为 L5-S1 高位先天性脊椎滑脱；1 例患者因之前未控制的骨髓炎导致 L5 椎体溶解，在之前失败的融合后出现；1 例患者因之前 L3-S1 融合后发生医源性 L5-S1 脊椎滑脱。1 例患者出现内侧放置的椎弓根螺钉和相关神经根病变。所有术后随访的术后扫描均显示融合牢固。术后，前滑脱从 18.3%改善至 10.1%（p=0.0586），滑脱角从 60.43°的后凸改善至 48.71°（p=0.0139）。除在骶骨垫上定位以增加前凸角外，术中未尝试任何脊椎滑脱平移复位操作。腰椎前凸从术后的 65.29°改善至 63.86°。我们的 14 名患者中有 4 名进行了长达 28 个月（范围 19-48 个月）的长期随访，滑脱角、百分比和腰椎前凸均从患者术前的测量值改善。滑脱角的改善具有统计学意义，p 值为 0.065。
在寻求解决相邻节段不稳定或滑脱时，反向 Bohlman 技术是治疗高度脊椎滑脱的可行选择。
