Are you researching the TOPS System as an alternative to spinal fusion? If so, you might have run across a couple of other options—including artificial disc replacement (ADR) and BalancedBack Total Joint Replacement—and are wondering about the differences between them all. In this article, we’ll explain what the TOPS System is, and put it in context with other motion surgeries to help you understand which solution may be right for you.
3 Motion Surgeries Explained: TOPS System, ADR, & The BalancedBack Procedure
If you’re searching for an alternative to fusion, then you may already realize the importance of motion to a healthy spine. Spinal mobility is the key to maintaining a healthy, balanced spine (sometimes called “sagittal” balance). When you eliminate a joint (which is what happens in a fusion), it places tremendous stress on your back, and may accelerate the degeneration of your spine.
Motion surgeries can relieve various symptoms, such as leg and/or back pain, while keeping the joints of your spine intact. These surgeries range from minimally invasive decompressions to joint reconstructions. The TOPS spinal implant is one such surgery, as are ADR and the BalancedBack device.
The TOPS System
The TOPS spinal implant provides stabilization after decompression. It is indicated for people who have lumbar spinal stenosis (painful nerve compression due to the narrowing of the areas they pass through, such as the spinal canal) and grade 1 spondylolisthesis (forward slippage of a disc in the spinal column) and a nearly normal disc in the affected level. This is an incredibly rare and unusual combination of pathologies.
TOPS consists of titanium plates connected by a polyurethane boot. The device is implanted using four standard polyaxial pedicle screws (much like those used in a fusion).
It is important to consider potential pain from the untreated disc and the prominence of the device itself when considering a TOPS procedure, as well as the underlying biomechanical principles of the device. It is unclear how TOPS restore the biomechanics of the spine, however the device is currently in a US IDE Study.
ADR—Artificial Disc Replacement
Artificial disc replacement, or anterior disc replacement, is in many ways the opposite of TOPS, where a patient must have abnormal disc and no other pathology.
The indications for this surgery are also very narrow.1 Patients who would benefit from ADR generally have a degenerated disc, normal facets joint and little to no stenosis.
The scenario of isolated anterior disc disease is rare. Most people with back and leg pain have other, additional issues besides a degenerating disc, which could prevent this surgery from being successful.
For example, discs and facet joints both typically experience a degree of wear and tear over time, making it unlikely that a new disc alone would solve the problem. If left alone, arthritic facet joints will still cause pain even with a new disc in place. And in addition to the back pain caused by a worn-out disc, many people have leg pain from a pinched nerve. Again, a new disc would solve only part of the problem. The anterior approach used by surgeons does not allow for pinched nerves to be addressed.
BalancedBack Total Joint Replacement
ADR and the TOPS spinal implant can work well for people with very specific conditions. But if you don’t meet the criteria for either of the motion surgeries listed above, there’s another option that is appropriate for a wider range of patients: BalancedBack Total Joint Replacement.
The BalancedBack device replaces the function of both the facet joints and the disc, and allows for a full decompression to relieve spinal stenosis. Plus, the BalancedBack device is zero profile, entirely within the margins of the bones, and not protruding into painful muscle tissue like a fusion construct of TOPS. The BalancedBack procedure uses a posterior approach, including decompression and discectomy, allowing surgeons to address a broad range of issue including:
- Degenerative disc disease
- Moderate to severe facet joint arthritis
- Spinal stenosis
- Grade 1 spondylolisthesis
- Recurring herniated discs
BalancedBack is generally the only motion-preserving option for patients with both leg and back pain. Like fusion, a BalancedBack Total Joint Replacement procedure may be appropriate for as many as 75% of patients, as opposed to an estimated 5% for ADR.
Whatever your condition, choosing the right treatment starts with understanding the various types of surgeries and what they are intended to address, as well as knowing the long-term consequences of the procedure you choose. For most patients, there are better alternatives to fusion that can relieve your symptoms and preserve motion—it’s simply a matter of choosing the right one for you.
Want to learn more about BalancedBack surgery?
BalancedBack Total Joint Replacement is an advanced treatment for leg and back pain currently available outside of the United States.
To find out more about the BalancedBack experience and see if you may be a potential candidate, visit our website.
1 Gelalis, I. D., Papadopoulos, D. V., Giannoulis, D. K., Tsantes, A. G., & Korompilias, A. V. (2018). Spinal motion preservation surgery: indications and applications. European Journal of Orthopaedic Surgery & Traumatology, 28(3), 335-342.