1465. A novel application of Sacro-iliac joint fusion system for high-grade Spondylolisthesis using “Reverse Bohlman technique”: a technical report and overview of the literature

Authors: Mayur Sharma, MD, MBBS; Zaid Aljuboori, MD; Jared Clouse, MD; Richard Rodgers, MD; Thomas Altstadt, MD (Louisville, KY)

Introduction: High- grade Spondylolisthesis (HGS) is a complex clinical problem that poses significant challenges to the treating physician. There is a contentious debate regarding the most optimal surgical approach in these patients. A variety of trans-sacral and transvertebral techniques have been described in the literature. Methods and Results: In this report, we present two cases of 35-year-old and 26-year-old Caucasian females who presented with low back pain and radicular symptoms. CT and MRI scan revealed progressive HGS (Grade II - III ), which was not relieved with conservative measures. They underwent transsacral fixation using Reverse Bohlman technique (RBT) at L5-S1, L4-5 Anterior lumbar interbody fusion (ALIF) combined with postero-lateral fusion (PLF). At 9 and 10 months follow up, patients reported minimal back pain with no radicular symptoms and imaging showed satisfactory fusion in both patients. Conclusion: This is the first report to demonstrate the utility of SI joint fusion cage(using RBT) in patients with HGS with successful clinical outcome. This technique is safe, feasible , and effective in carefully selected patients.