改良博尔曼法治疗小儿重度腰椎滑脱症：来自连续病例系列的超过2年随访数据
The Modified Bohlman Method for Pediatric High-Grade Spondylolisthesis: Greater than 2-year Follow-up Data From a Consecutive Case Series.
作者信息
Petty Dominique L, Li T Peter, Henstenburg Jeffrey M, Noonan Kenneth J
机构信息
Department of Orthopaedics and Rehabilitation, University of Wisconsin, American Family Children's Hospital, Madison, WI, USA.
出版信息
J Pediatr Soc North Am. 2025 Jun 20;12:100229. doi: 10.1016/j.jposna.2025.100229. eCollection 2025 Aug.
BACKGROUND
The modified Bohlman method (mBm), which incorporates an allograft strut, standard bone screws, and posterior lateral fusion, offers a potential alternative for achieving stable arthrodesis in high-grade spondylolisthesis (HGS). This study presents the clinical, radiographic, and patient-reported outcomes in a consecutive case series of pediatric patients treated with the mBm at a single institution.
METHODS
A retrospective review was performed on seven patients under 18 years of age with HGS (Meyerding grade ≥3) who underwent surgical treatment with the mBm between 2009 and 2022. Radiographic spinopelvic parameters were analyzed preoperatively, postoperatively, and at final follow-up. Radiographic fusion was assessed using Brantigan-Steffee criteria. Clinical outcomes, complications, and patient-reported outcome measures, Oswestry Disability Index, and Scoliosis Research Society-22r (SRS-22r) were collected at a minimum follow-up of 2 years.
RESULTS
All 7 patients achieved radiographic fusion at L5-S1 at an average radiographic follow-up of 4.7 years. There was no evidence of implant loosening or the need for revision surgery. Following surgery, improvements were observed in slip angle, lumbosacral angle, and sacral slope. The median ODI score was 3.5% (range 0-10%), and the mean SRS-22r score was 4.4, suggesting excellent long-term functional outcomes. The average implant cost for the mBm was $5,350.
CONCLUSION
The mBm provides reliable fusion, favorable spinopelvic alignment, low disability rates, and a cost-effective solution for managing HGS. These findings support the use of the mBm as a safe and effective treatment option for HGS in appropriately selected patients.
KEY CONCEPTS
(1)The modified Bohlman method (mBm) for high-grade spondylolisthesis employs an allograft strut and 6.5 mm stainless steel bone screws to achieve posterior lateral fusion with reliable rates of solid arthrodesis at a minimum of 2 years follow-up.(2)This technique is associated with reductions in slip angle and improvements in lumbosacral alignment, supporting the creation of a stable "neo-sacrum."(3)At greater than 2 years follow-up, patients treated with the mBm demonstrated functional outcomes comparable to published normative values, as measured by the Oswestry Disability Index and Scoliosis Research Society-22r.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
背景
改良的博尔曼方法（mBm），采用同种异体骨支柱、标准骨螺钉和后外侧融合术，为重度腰椎滑脱（HGS）实现稳定的关节融合提供了一种潜在的替代方法。本研究展示了在单一机构接受mBm治疗的一系列连续儿科患者的临床、影像学和患者报告的结果。
方法
对2009年至2022年间7例18岁以下的HGS（迈耶丁分级≥3级）患者进行回顾性研究，这些患者接受了mBm手术治疗。术前、术后及末次随访时分析影像学上的脊柱骨盆参数。采用布兰特igan - 斯特菲标准评估影像学融合情况。在至少2年的随访中收集临床结果、并发症及患者报告的结果指标，如奥斯维斯特里残疾指数和脊柱侧弯研究学会 - 22r（SRS - 22r）。
结果
所有7例患者在L5 - S1均实现了影像学融合，平均影像学随访时间为4.7年。没有植入物松动或需要翻修手术的迹象。术后，滑脱角、腰骶角和骶骨斜率均有改善。奥斯维斯特里残疾指数（ODI）中位数为3.5%（范围0 - 10%），SRS - 22r平均评分为4.4，表明长期功能结果良好。mBm的平均植入成本为5350美元。
结论
mBm为治疗HGS提供了可靠的融合、良好的脊柱骨盆对线、低残疾率和具有成本效益的解决方案。这些发现支持将mBm作为在适当选择的患者中治疗HGS的一种安全有效的治疗选择。
关键概念
（1）用于重度腰椎滑脱的改良博尔曼方法（mBm）采用同种异体骨支柱和6.5毫米不锈钢骨螺钉，以实现后外侧融合，在至少2年的随访中获得可靠的坚实关节融合率。（2）该技术与滑脱角减小和腰骶对线改善相关，有助于创建稳定的“新骶骨”。（3）在超过2年的随访中，接受mBm治疗的患者的功能结果与已发表的标准值相当，通过奥斯维斯特里残疾指数和脊柱侧弯研究学会 - 22r进行测量。
证据级别
IV级，回顾性病例系列。
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