Motion-preserving spinal implant minimizes back pain and leg issues

By Michael Jones, MD, neurosurgeon

An innovative treatment option is available for patients experiencing debilitating lower back and leg pain. The total posterior spine system (TOPS) is an enhanced motion-preserving surgical implant that addresses two critical functions of the spine – maintaining stability and preserving motion.

For eligible patients with lumbar compression, the bilateral cushion-bearing and articulating implant is designed to minimize back pain as well as tingling, weakness, pain and numbness in the legs.

Unlike spinal fusion surgery, the implant allows some movement at the surgical site, providing an additional option for eligible patients ages 35 to 80 who have spinal stenosis (the space around the spinal cord is too narrow) and spondylolisthesis (a vertebrae slips out of position and contacts the one below it).

While many treatment options are available for spinal pain, patients with spinal stenosis and other specific conditions have historically had two general options to address their symptoms. Minor degeneration can be addressed with simple decompression, a surgical procedure that removes a small portion of bone, disc material or both, to relieve pressure on the nerve roots in the lower back.

Severe degeneration requires more aggressive decompression that involves fusion. Fusion ensures the spine does not become unstable and often involves removing spinal joints. Fusion can actually accelerate degeneration at adjacent levels of the spine and eliminate motion at the point of fusion.

TOPS allows neurosurgeons to perform aggressive decompression while retaining the biomechanics of the spine, preserving motion. It is essentially a spinal joint replacement and may be a viable option for people who meet the surgical criteria and are considering spinal fusion. The procedure is a particularly good option for patients who want to maintain motion in their spine and return to active lifestyles more quickly than a fusion allows.

The implant is designed to facilitate bending, straightening and twisting movements with reduced pain. When compared with traditional spinal fusion, TOPS patients experience a faster recovery and fewer restrictions during recovery. Two years after surgery, more patients report significant improvement in daily activity and fewer required repeat operations.

During surgery, the device is inserted in the lumbar vertebral joint and affixed to the spine with screws. The size of the implant is matched to the patient’s spine.

The implant is manufactured by Premia Spine and distributed in the U.S. by Medtronic. First used in Europe in 2005, the device has since been enhanced in a number of ways, including new materials and sizes. TOPS was the subject of a 24-month study in the U.S. before receiving FDA approval.

Prior to the introduction of TOPS, lumbar fusion was the gold standard in surgical treatment for low-grade degenerative spondylolisthesis with stenosis. Globally, the TOPs device has a success rate of 77%, compared with 24% for fusion.

Michael Jones, MD, is a neurosurgeon with ProHealth Neuroscience Care. As part of ProHealth’s spine team, he works with patients to help them control back or neck pain and restore movement, strength and flexibility. In October 2023, he implanted the first TOPS device in Wisconsin at ProHealth Waukesha Memorial Hospital.