The TOPS procedure, or Total Posterior Spine system, is a surgical option that helps stabilize the lower back after decompression surgery. It uses a motion-preserving implant and offers an alternative to traditional spinal fusion.

Instead of permanently joining the vertebrae together, the TOPS device replaces the bone and soft tissue removed during surgery. This helps keep more natural movement and flexibility in the spine.

How the TOPS Procedure Works

Decompression: The surgeon first removes the parts of the spine that are pressing on the nerves, such as bone spurs, worn joints, or thickened ligaments.

Implantation: Rather than using bone grafts and rigid rods to fuse the spine, the surgeon secures the TOPS device with four pedicle screws.

Motion Preservation: The implant is made with titanium and a flexible polycarbonate urethane core. This design works like a shock absorber and artificial joint, letting the spine move naturally while helping prevent harmful slipping.

Conditions It Treats

The TOPS system is FDA-approved for certain patients, usually ages 35 to 80, who have:

  • Lumbar spinal stenosis: A narrowing of the spinal canal that can cause pain in the buttocks or legs.
  • Degenerative spondylolisthesis: A condition where one vertebra slips forward over another, usually up to Grade 1.

TOPS vs. Traditional Spinal Fusion

Traditional spinal fusion is still considered a standard for surgical treatment in lumbar stenosis and degenerative spondylolisthesis cases. However, the TOPS procedure offers certain benefits for patients who are good candidates for the surgery.

TOPS Procedure:

  • Preserves natural movement, including bending and twisting.
  • May reduce stress on nearby discs and vertebrae.
  • Often involves a 1 to 2 night hospital stay, with a return to activity in about 6 weeks.

Traditional Spinal Fusion:

  • Stops motion at the treated level.
  • Can place more stress on nearby discs, which may lead to faster wear.
  • Recovery may take several months to a year while the bones fully fuse.