Use of Rialto Sacroiliac Fusion Implant for Trans-Sacral Fixation (Bohlman Technique) for High Grade L5 Listhesis Treatment: A Series of Cases

The article begins with a brief biography of Sr. Henry Bohlman, a great orthopedist and person with strong impact on modern Medicine and Spine surgery. Using the original Bohlamn technique with small modifications (instead of fibula graft used Rialto implant and performing posterior fixation L4-S2) we treated surgically two young females with high grade L5 listhesis and a case of postoperative pseudarthrosis after lumbosacral fixation with success. The detailed, staged surgical technique is described, also with description of pitfalls and their avoidance.

Methods: The patients were followed up during 2 year and 9 months and 2 year and 7 months, the third patient´s follow up is shorter, because is a recent case.

Results: Two young females of 18 years old with isthmic listhesis L5 were submitted to fixation L4-S2 and trans-sacral, trans-dical fusion with Rialto implant by Bohlman technique with partial reduction of listhesis. Both had resolution of the pain and has maintained a good clinical outcome at 1 years and 9 months and another one at 1 year and 7 months follow up. The third case, 79 years old male, was a postoperative pseudarthrosis L5-S1 solved with the use of the same type of trans-sacral implant, associated with S2 SAI screws.

Conclusions: Circumferential fusion is a robust arthrodesis with a low risk of pseudarthrosis, fusion without reduction is advised in patients with a balanced pelvis, acceptable global sagittal balance, few neurological symptoms. Partial reduction may be achieved during the fixation after posterior bonny elements removal of L5 vertebra. In-situ fixation can be augmented with trans-sacral Rialto implant.