Gasless endoscopic anterior lumbar interbody fusion utilizing the BERG approach

Background: Several authors have reported success using a gas-mediated tran speritoneal approach for lumbar interbody fusion. However, this approach ha s not been shown to reliably and predictably address segments above L4-5. Methods: The B.E.R.G. approach was attempted in 202 patients who required a nterior lumbar interbody fusion (ALIF). Of those, 168 were completed succes sfully without conversion to an open procedure. The anterior retroperitonea l approach required no gas insufflation. The gasless environment allowed fo r the use of standard anterior instrumentation and a variety of fusion graf ts and devices. Results: Mean hospital stay was 1.95 days, with 73% of patients discharged in <47 h following surgery. Clinical results from the first 50 patients, wi th a minimum 2-year follow-up, include a 92% fusion rate and 78% of patient s reporting significant pain relief of greater than 50%. Conclusions: The B.E.R.G. approach offers significant technical advantages over the standard gas-mediated transperitoneal approach for ALIF. The clini cal results are similar to those reported for open approaches and the gas-m ediated transperitoneal approach.