Surgeons and patients often question where the different non-fusion technologies fit along the continuum of care.  The TOPS™ System is a motion preservation device designed to treat posterior problems.  Patients with primary back pain or discogenic pain are better served with anterior column implants such as a disc replacement or nucleus replacement.  For spinal stenosis, spondylolisthesis, and facet arthrosis, the device treatment options including interspinous process devices, dynamic stabilization devices, facet replacement, and total posterior arthroplasty.

 

relative to the TOPS™ System?
The interspinous process devices are indicated for patients

with mild to moderate lumbar stenosis. These patients are

relatively early in the degenerative cascade. Some patients

achieve natural pain relief by hunching over, thereby creating

additional space in the spinal canal. The interspinous process

devices essentially do the same thing, by blocking extension

and maintaining some distraction of the posterior spinal

elements to keep the spinal canal open. These devices cannot

be used in patients who require a decompression of the

lamina or facet joints to eliminate nerve impingement.  These

more severe patients require more robust implants to provide

stabilization and motion at the operative level.  The TOPS™

System better serves this group of patients.

 

 

versus that of dynamic stabilization systems?
The key differentiator is the amount of instability present at

the diseased spine segment.  In unstable segments (e.g.,

spondylolisthesis), dynamic stabilization devices are not well

suited to withstand the constant translation forces on the

spinal column.  These sheer forces are a major source of pain

for patients with spinal stenosis, facet arthrosis, and

spondylolisthesis.  Because of its robust design, the TOPS™

System is a better suited for patients with instability.  As this

condition typically arises later in the degenerative process,

the only alternative until today is posterior fusion.

 

 

 

facet replacement devices?
The TOPS™ System is more than a facet replacement device.

It is a Total Posterior Arthroplasty device, such that it

effectively replaces the anatomical structures that are

removed during the decompression procedure.  For example,

the internal metal stoppers replace the natural bony elements

that served as stoppers during axial rotation.  The boot and

internal components take the place of the supraspinous

ligament, interspinous ligament, and ligamentum flavum in their

ability to help control flexion.

 

 

 

 

So when is fusion the solution of choice?
Fusion is the optimum standard of care for the most

complicated cases, such as patients who: