Denver spine surgeon Joshua Beckman, MD, FAANS, with Denver-based Neurosurgery One, recently performed Colorado’s first spinal surgery with the TOPS™ System. Unlike traditional spinal fusion, which permanently welds two or more joints of the spine together and limits mobility, the Total Posterior Spine (TOPS) facet joint replacement system preserves motion while improving spinal stability.
“This motion-preserving system allows us to completely remove the facet joint, decompress the spinal nerves, and implant the TOPS™ System to stabilize the joint while retaining motion in all directions,” Dr. Beckman said.
The first Colorado patient to undergo the procedure after the system received approval from the Food and Drug Administration (FDA) was Tom Martino, consumer advocate and host of the “Troubleshooter Radio Show.”
Martino had been plagued with chronic, sometimes debilitating, lower back pain since his 40s due to arthritis and stenosis. He also had deterioration of his facet joints, which was causing radiating pain down his lower back and leg, a condition known as sciatica or radiculopathy.
Martino underwent decompression surgery, performed by Dr. Beckman, in 2022. While the surgery was successful, Martino had arthritis and sciatica that couldn’t be addressed without compromising mobility and stability, so he opted to wait for FDA approval for the new procedure.
“After less than a week, I was pain free and able to move side to side,” said Martino, after undergoing spinal surgery with the TOPS™ System on August 9, 2023.
Dr. Beckman had read about the TOPS™ system in research articles and felt it would be the best option for Martino. Premia Spine received FDA approval of its TOPS™ System in June 2023.
“There is research from Europe dating back to 2015 validating the safety and effectiveness of the TOPS System,” Dr. Beckman said. “I spoke with surgeons who had participated in clinical trials and discussed Tom’s case with them. Everyone agreed it was the right option for his condition and goals.”
The TOPS™ System is best suited for healthy, active patients who are suffering from chronic low back pain and want to maintain mobility and flexibility. The system allows for motion in all directions – flexion, extension, lateral bending, and axial rotation.
The TOPS™ System had previously earned the FDA’s Breakthrough Designation status and successfully completed an FDA trial that showed it was a valid option to fusion with similar outcomes for treating grade 1 degenerative spondylolisthesis with stenosis.
Lumbar fusion has long been the go-to spine surgery for both conditions. The TOPS™ System is the first alternative to lumbar fusion for some patients. However, it can only be used with patients who have good bone quality, no osteoarthritis, and only need one level of the lumbar spine between levels L1 and L5 treated, Dr. Beckman said. It cannot be used to treat disease in the L5-S1 joint, the joint between the lower back and sacrum that is a frequent trouble spot.
“This device allows us to completely remove the facet joint,” Dr. Beckman said. “It’s a great alternative to lumbar fusion in specific patients. It’s had good results so far, but we will be following the long-term data closely.”
In a clinical trial of patients 24 months after the procedure, there was a 76.7% overall success rate. Another clinical study found “lumbar facet arthroplasty with the TOPS device demonstrated a statistically significant improvement in all patient-reported outcome measures.”
The procedure takes 2-3 hours depending on the patient and circumstances. Dr. Beckman has 4-5 patients already scheduled for spinal surgery using the TOPS™ System and looks forward to offering the back surgery option to more patients who fit the criteria in the future.
Patients interested in scheduling an appointment to find out if they are a candidate for TOPS surgery can make an appointment with any of the spinal physician assistants at Neurosurgery One Lakewood by calling 720-638-7500, ext. 2.
Dr. Joshua Beckman, MD, FAANS, is a board-certified neurosurgeon who specializes in spine surgery. Dr. Beckman sees patients in the Neurosurgery One Lakewood. Prior to joining Neurosurgery One, Dr. Beckman served as the director of spine surgery at San Antonio Military Medical Center, the nation’s largest military hospital and Level I trauma center where he developed special expertise in treating severe spinal injuries.
