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.