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.