New System Preserves Motion after Spinal Fusion

A new system mimics the function of the posterior spine elements, allowing surgeons to decompress and stabilize the impaired posterior spinal segment in patients with two-level disc disease, without sacrificing motion.

The TOPS-on-Fusion system (TOPS) is a total posterior motion preservation device that integrates lumbar fusion with total posterior arthroplasty at two adjacent levels, sharing the loads with the native disc and protecting the anterior column from excessive movements. The device is indicated for L3-L5 and L4-S1 patients where the inferior segment is fused and the superior level is treated with total posterior arthroplasty, and is designed to stabilize (but not fuse) the affected vertebral level to alleviate pain stemming from spinal stenosis with or without degenerative facet arthrosis and spondylolisthesis.

Following a laminectomy and medial facetectomy, the device is affixed to the spine via four pedicle screws using a standard posterior surgical approach. The system effectively replaces the anatomic structures that are removed during the decompression procedure. 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. The TOPS-on-Fusion system is a product of Impliant (Princeton, NJ, USA). The system has received CE Mark approval, and is undergoing clinical trials in the United States.

"It is common to have patients with advanced disc and posterior disease at one level and isolated posterior problems at the adjacent level,” said Dr. Louis Nel, M.D., a senior spine surgeon who performed the procedure at Eugene Marais Hospital (Pretoria, South Africa). "The TOPS-on-Fusion system stabilizes both segments while allowing motion at the level adjacent to fusion by effectively replacing all the posterior structures removed during the decompression. I was very satisfied with the simplicity and ease of the procedure.”


Related Links:
Impliant
Eugene Marais Hospital