TOPS™ Spine System

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What Is the TOPS™ System?

The TOPS™ (Total Posterior Spine) System is an FDA approved spinal implant designed to stabilize your lower back while maintaining your natural range of motion. Unlike traditional spinal fusion, which permanently locks vertebrae together and eliminates movement, TOPS acts as a mechanical facet joint replacement that preserves your spine’s ability to bend, twist, and flex.

How It Works

Think of the TOPS device as a sophisticated shock absorber for your spine. The system consists of two titanium crossbars that attach to pedicle screws in your vertebrae, connected by a central motion mechanism. This unique design includes a polycarbonate urethane boot housing internal articulating parts that allow controlled movement between the vertebrae.

During the procedure, your surgeon performs a complete decompression, removing the damaged facet joints, overgrown bone, and thickened ligaments that are compressing your nerves. The TOPS System is then implanted to restore stability while preserving motion in all directions: flexion, extension, lateral bending, and axial rotation. Critically, it also blocks harmful shear forces that can worsen conditions like spondylolisthesis.

What Are the Benefits of TOPS?

The TOPS System offers transformative advantages for patients who want to avoid the limitations of traditional fusion while still addressing severe spinal stenosis and instability.

The TOPS procedure delivers immediate and sustained relief from both back pain and leg pain. In the FDA clinical trial, patients experienced significant improvements in pain scores, physical function, and overall quality of life, all while retaining the ability to move naturally.

The TOPS approach allows for complete removal of the damaged structures causing nerve compression. Unlike some motion preservation techniques that require preserving compromised anatomy, TOPS enables thorough decompression of neural elements.

With our enhanced recovery protocols combined with motion preservation, many patients experience quicker rehabilitation and return to their personal goals faster than with traditional fusion.

tops system computer image

What Conditions Does TOPS Treat?

The TOPS System offers hope for patients suffering from debilitating lower back and leg pain caused by spinal stenosis and instability. If you’ve been told fusion is your only option, or if you’re experiencing symptoms that limit your daily activities and quality of life, TOPS may provide the motion preserving solution you’ve been searching for.

  • Moderate to Severe Lumbar Spinal Stenosis: Narrowing of the spinal canal causing compression of nerves, resulting in leg pain, numbness, weakness, or difficulty walking
  • Spondylolisthesis: Forward slippage of one vertebra on another due to wear and tear of the facet joints
  • Ligamentum Flavum Thickening: Overgrowth of the ligaments in the back of the spinal canal contributing to nerve compression
  • Facet Joint Arthrosis/Cysts: Arthritic changes and cyst formation in the facet joints causing pain and instability

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VSI Performs East Coast’s First Customized TOPS Surgery

VSI Spine Surgeon Dr. Ehsan Jazini has achieved a landmark milestone in motion preservation spine surgery, completing the first customized two-level lumbar disc replacement combined with the TOPS™ System on the East Coast, and only the second nationwide. This groundbreaking procedure represents a shift in treating complex spinal conditions, offering patients a motion-preserving alternative to traditional multi-level fusion surgery.

By combining advanced disc replacement technology with the innovative TOPS System, Dr. Jazini delivered a comprehensive 360-degree reconstruction that restored both stability and natural motion across two spinal levels.

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What are the Benefits of TOPS vs. Traditional Spinal Fusion?

Traditional lumbar fusion has been the standard surgical treatment for spinal stenosis with spondylolisthesis for decades. But fusion comes with significant trade offs that many patients should consider before making a shared decision with their surgeon.

Spinal Fusion Surgery

  • Permanent loss of motion at fused segments
  • Dramatically reduced flexibility in your lower back
  • Increased stress on adjacent levels, leading to accelerated degeneration
  • Longer recovery periods with restricted activities

The Advantage of TOPS

  • Maintained range of motion in all directions
  • Fewer complications and re-operations
  • Better daily function and activity levels
  • Superior pain relief outcomes
  • Preserved spinal biomechanics protecting against future problems

Frequently Asked Questions on the TOPS Procedure

Yes. The TOPS System received FDA Premarket Approval in June 2023 with a rare “superior to fusion” designation based on clinical trials showing 77% success rates. The FDA also designated TOPS as a Breakthrough Technology in 2020, recognizing its potential to provide more effective treatment for lumbar spinal stenosis and spondylolisthesis.

The TOPS procedure typically takes 2 to 3 hours, though the duration depends on your specific anatomy and complexity of decompression required.

TOPS achieved a 77% overall clinical success rate in FDA trials, including improvements in leg pain, physical function, and neurological status. Clinical studies since 2005 consistently show TOPS alleviates persistent leg and back pain for patients with moderate to severe spinal stenosis, with patient reported positive outcomes and many patients experiencing immediate and sustained pain relief.

Most TOPS patients stay in the hospital for 1 to 3 days depending on your overall health, whether additional procedures were performed, your pain control and ability to mobilize safely, and any complications requiring monitoring. Patients undergoing combined TOPS and disc replacement procedures may stay 2 to 3 days to ensure complete recovery from both approaches, and our goal is to discharge you when you’re safe, comfortable, and confident in your ability to care for yourself at home.

Return to work timing varies based on your job’s physical demands: desk work or light duty jobs typically 2 to 4 weeks with initial accommodations, moderate physical work typically 6 to 8 weeks with gradual activity increases, and heavy labor or physically demanding jobs may require 3 to 6 months with clearance based on your strength and endurance. One major advantage of TOPS over fusion is faster return to full activities since motion is preserved rather than eliminated, allowing your rehabilitation to progress more quickly once initial healing occurs.

Yes, physical therapy is essential for optimal recovery. At VSI, your spine care team includes in house, spine specialized physical therapists who are experts in spine surgery rehabilitation and work hand in hand with our surgeons to provide highly customized post surgical rehab tailored to your specific surgery.