Minimally invasive 360 degrees instrumented lumbar fusion

A retrospective preliminary study was undertaken of combined minimally inva sive instrumented lumbar fusion utilizing the BERG (balloon-assisted endosc opic retroperitoneal gasless) approach anteriorly, and a posterior small-in cision approach with translaminar screw fixation and posterolateral fusion. The study aimed to quantify the clinical and radiological results using th is combined technique. The traditional minimally invasive approach to the a nterior lumbar spine involves gas insufflation and provides reliable access only to L5-S1 and in some cases L4-5. A gas-mediated approach yields many technical drawbacks to performing spinal surgery. A minimally invasive post erior approach involving suprafascial pedicle screw instrumentation has bee n developed, but without widespread use. Translaminar facet fixation may be a viable alternative to transpedicular fixation in a 360 degrees instrumen ted fusion model. Past studies have shown open 360 degrees instrumented lum bar fusion yields high arthrodesis rates. The study examined the cases of 4 6 patients who underwent successful 360 degrees instrumented lumbar fusion using a combined minimally invasive approach. Anterior lumbar interbody fus ion (ALIF) at one or two levels was performed through the BERG approach; a gasless retroperitoneal approach to the lumbar spine allowing the use of st andard anterior instrumentation. Posteriorly, all patients underwent succes sful decompression, translaminar fixation, and posterolateral fusion at one or two levels through one small (2.5-5.0 cm) incision. Results showed mean hospital stay of 2.02 days; mean combined blood loss was 255 cc; and mean pain relief was 56%, with 75.5% of patients reporting good, excellent, or t otal pain relief. Forty-two of 46 patients (93.2%) achieved a solid fusion 24 months after surgery. A total of 47% of all patients working prior to su rgery returned to work following surgery. The study showed that minimally i nvasive 360 degrees instrumented lumbar fusion, when performed utilizing th ese approaches, yields a high rate of solid arthrodesis (93.3%), good pain relief, short hospital stays, low blood losses, accelerated rehabilitation, and a quick return to the workforce. The BERG approach offers technical ad vantages over the traditional gas-mediated laparoscopic approach to the ant erior lumbar spine.