A modified Bohlman technique using a novel implant for treatment of high-grade spondylolisthesis

Abstract

Several surgical options for managing high-grade spondylolisthesis have been described in the literature and range from posterior-only in situ fusion to circumferential fusion with complete reduction of the dislocation. The level of evidence supporting any one technique is weak, and to date there is no Level I or II evidence supporting any current surgical treatment option. Techniques have evolved as implant technology has advanced and surgeons have gained experience with deformity correction. Still, the paucity of cases at any one institution limits the ability to perform clinical studies in a prospective and randomized fashion. To the authors' knowledge, the use of the AxiaLif bolt in a modified Bohlman technique has not been described. In the setting of a case of symptomatic high-grade spondylolisthesis refractory to nonoperative management, the authors describe a modified Bohlman technique in which they used the AxiaLif bolt rather than the fibula graft that was originally described. They then supplemented this with pedicle screw instrumentation and an iliac crest autograft. At the 2-year follow-up exam, the patient exhibited relief of his preoperative back and leg pain and he had returned to all activities. The latest radiographs demonstrated successful fusion. A single-stage, posterior instrumented fusion in which the AxiaLif bolt is used in lieu of fibula autograft or allograft in a modified Bohlman technique is technically less demanding, does not have the morbidity associated with harvesting a fibula autograft, and carries no risk of disease transmission associated with the use of allograft.