For decades, patients diagnosed with lumbar spinal stenosis and spondylolisthesis who failed conservative care had essentially one surgical option: spinal fusion. Fusion works — it decompresses the nerves and stabilizes the spine — but it does so by permanently eliminating motion at the treated level. The TOPS Facet Replacement System offers a different approach: stabilizing the spine after decompression while preserving meaningful motion at the treated segment.
What Is the TOPS System?
TOPS stands for Total Posterior Solution. Developed by Premia Spine and FDA-cleared in the United States, it is a mechanical implant placed at a single lumbar level following a standard posterior decompression (laminectomy). Instead of fusing the vertebrae together with bone graft and rigid hardware, the TOPS device replaces the degenerated facet joints with a precision-engineered implant that allows controlled motion — flexion, extension, rotation, and lateral bending — while preventing the instability that drives spondylolisthesis and nerve compression.
In practical terms, TOPS treats the same pathology that fusion treats, but without permanently locking the segment in place. The device is anchored to the pedicles on either side of the treated level, similar to the pedicle screws used in fusion surgery, but the connecting element is dynamic rather than rigid.
Who Is a Candidate?
The TOPS system is designed for patients with Grade I degenerative lumbar spondylolisthesis — a condition where one vertebra has slipped forward on the one below it due to facet joint degeneration — combined with symptomatic spinal stenosis at the L3–L4 or L4–L5 level. Ideal candidates are adults who:
- Have persistent leg pain, numbness, or weakness from nerve compression
- Have failed an appropriate course of conservative treatment (physical therapy, injections, activity modification)
- Would otherwise be candidates for a single-level posterior lumbar fusion at L3–L4 or L4–L5
- Do not have significant osteoporosis, prior surgery at the target level, or multi-level instability
TOPS is not appropriate for every spine patient. Multi-level disease, severe osteoporosis, or structural problems that require rigid correction are better served by other surgical strategies. A thorough evaluation — including review of MRI, CT, and standing X-rays — is required to determine whether any individual patient is a good candidate.
How Does TOPS Compare to Fusion?
Both TOPS and posterior lumbar fusion address the same clinical problem — nerve compression from stenosis combined with segmental instability — through the same initial step: surgical decompression of the nerves. The difference is what happens next.
In a posterior lumbar interbody fusion (PLIF or TLIF), the disc space is prepared and filled with an interbody device and bone graft, and rigid pedicle screws and a rod are placed to hold the segment immobile while fusion occurs. Over a period of months to about a year, the bones grow together. Once fused, that level no longer moves.
With TOPS, the disc is left in place and the facet joints are replaced by the device. The segment retains controlled motion within a physiologic range. Clinical studies comparing TOPS to fusion have demonstrated comparable improvements in pain and leg symptoms, with TOPS patients maintaining measurable range of motion at the treated level.
What Is Recovery Like?
Because TOPS uses the same surgical approach as posterior fusion — a midline posterior incision with pedicle screw instrumentation — the initial recovery is similar. Most patients are walking the day of or the day after surgery. Hospital stay is typically one to two nights. Return to light activity generally occurs within two to four weeks; more demanding physical activity follows at six to twelve weeks depending on individual progress.
One difference from fusion is that there is no bone healing to wait for. Fusion patients are often restricted from certain activities for three to six months while the fusion matures. With TOPS, stabilization is immediate and the recovery timeline does not include a fusion consolidation phase.
TOPS at Neuroscience Specialists in Oklahoma City
Dr. Jacob B. Archer performs TOPS facet replacement as part of a comprehensive approach to complex spine surgery and adult spinal deformity at Neuroscience Specialists. For patients with single-level spondylolisthesis and stenosis who are motivated to preserve motion, TOPS represents a meaningful advance over the standard fusion-only approach. If you have been told you need lumbar fusion and want to understand whether a motion-preserving alternative is appropriate for your situation, a consultation at our Oklahoma City office is the right next step.