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 problemthatposes 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.