• Mayur Sharma, Zaid Aljuboori, Jared William Clouse, Richard Rodgers, and Thomas Altstadt.
• Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
• World Neurosurg. 2019 Apr 1; 124: 331339331-339.

Objective/BackgroundHigh-grade spondylolisthesis (HGS) is a complex clinical problem that poses significant challenges to the treating physician. Contentious debate has continued regarding the most optimal surgical approach for these patients. A variety of transsacral and transvertebral techniques have been described in reported studies.Methods And ResultsWe present 2 cases of low back pain and radicular symptoms. Our 2 patients were a 35-year-old woman and a 26-year-old white woman. The computed tomography and magnetic resonance imaging scans revealed progressive HGS (grade III) that had not been relieved by conservative measures. Both patients underwent transsacral fixation using the reverse Bohlman technique (RBT) at L5-S1 and L4-L5 anterior lumbar interbody fusion combined with posterolateral fusion. At the 9- and 10-month follow-up visits, the patients reported minimal back pain with no radicular symptoms, and the imaging studies showed satisfactory fusion in both patients.ConclusionsTo the best of our knowledge, this is the first report to demonstrate the utility of the sacroiliac joint fusion cage using RBT in patients with HGS with successful clinical outcome. The RBT is safe, feasible, and effective in carefully selected patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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