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World Neurosurg. 2019 Aug 6. pii: S1878-8750(19)32145-X. doi: 10.1016/j.wneu.2019.07.229. [Epub ahead of print]

Grade II Spondylolisthesis: Reverse Bohlman Procedure with Trans-Discal S1-L5 and S2Ai Screws Placed with Robotic Guidance.

Author information

1
Department of Neurosurgery, Stanford University School of Medicine.
2
Department of Orthopedic Surgery, Stanford University School of Medicine.
3
Department of Neurosurgery, Stanford University School of Medicine. Electronic address: Anandv2@stanford.edu.

Abstract

STUDY DESIGN:

Technical Report with two illustrative cases.

OBJECTIVE:

Grade II spondylolisthesis remains a complex surgical pathology for which there is no consensus regarding optimal surgical strategies. Surgical strategies vary regarding extent of reduction, utilization of instrumentation/interbody support, and anterior versus posterior approaches with or without decompression. The objective of this study is to provide the first report on the efficacy of robotic spinal surgery systems in supporting the treatment of grade II spondylolisthesis.

METHODS:

Utilizing two illustrative cases, we provide a technical report of how a robotic spinal surgery platform can be utilized to treatment grade II spondylolisthesis with a novel instrumentation strategy.

RESULTS:

We describe how utilization of the "Reverse Bohlman" technique to achieve a large anterior fusion construct spanning the pathologic level and buttressed by the adjacent level above, coupled with a novel, high fidelity posterior fixation scheme with transdiscal S1-L5 and S2Ai screws placed in a minimally invasive fashion with robot guidance allows for the best chance of fusion in situ.

CONCLUSIONS:

The "Reverse Bohlman" technique coupled with transdiscal S1-L5 and S2Ai screw fixation accomplishes the surgical goals of creating a solid fusion construct, avoiding neurologic injury with aggressive reduction, and halting the progression of anterolisthesis. Utilization of robot guidance allows for efficient placement of these difficult screw trajectories in a minimally invasive fashion.

PMID:
31398524
DOI:
10.1016/j.wneu.2019.07.229

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