Treatment of High Grade Isthmic Spondylolisthesis by Anterior Lumbar Interbody Fusion with Structural Fibular Allograft

Abstract

The treatment for high-grade spondylolisthesis remains controversial. Although several techniques are commonly used, several variables for each patient need to be considered in the decision making process. In addition to the patient’s diagnosis, symptoms, age, bone quality, slip level, and slip grade, severe slip angles present an increased challenge to many approaches. We describe a reverse Bohlman technique with one anterior-to-posterior transdiscal structural fibular allograft at L5-S1, standard anterior interbody fusion at L4-L5, and a minimally invasive L4-S1 posterolateral spinal fusion with instrumentation from S1 into the L5 vertebral body that we have used successfully to treat a high grade isthmic spondylolisthesis. To our knowledge, this is the first description of a minimally invasive posterior approach in combination with an anterior reverse Bohlman technique to address high-grade spondylolisthesis.