Gasless endoscopic anterior lumbar interbody fusion utilizing the B.E.R.G. approach

Background: Several authors have reported success using a gas-mediated transperitoneal approach for lumbar interbody fusion. However, this approach has 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 anterior lumbar interbody fusion (ALIF). Of those, 168 were completed successfully without conversion to an open procedure. The anterior retroperitoneal approach required no gas insufflation. The gasless environment allowed for the use of standard anterior instrumentation and a variety of fusion grafts and devices. Results: Mean hospital stay was 1.95 days, with 73% of patients discharged in