@rstark I looked up the TOPS procedure. It's sounds like they are removing part of a vertebrae around the foramen where the nerves exit the spinal cord. Then they put a device there that can move similar to the way the artificial disc can move. They leave your disc in place. What comes to my mind is the question about if there is any spinal cord compression that may be caused by a disc herniation or bone spurs. I think the parameters for this said that it is for use when there is not a herniation. There are stages a disc goes through as it bulges before a herniation happens. It's worth asking what would happen then, if the disc can degenerate further? Does this device provide enough support and take weight off the disc?

Good questions. The surgeon I spoke to said I was a great a candidate, but then added if it doesn't work out you can go back in and do a fusion (yikes!) I'm going to do everything I can to not have surgery. I hope to be scheduled for a radio frequency ablation (RFA - out patient) of the medial branch in the next month or so . . .

@jenniferhunter Thank you for taking the time to watch the video and reply. How did you find out you are allergic to titanium? I hope it was before any procedure involving it. I guess I also need to know about my bone quality. I'm in pretty good shape, spine issues notwithstanding, I assume my bone quality is good. I do not have a collapsed disc, rather a disc bulge, severe bilateral facet arthrosis, and severe (grade 1) stenosis at L4-L5. I'll look at the video more closely and follow your advice about looking up some of the detailed information.

I understand there are surgeons at the Mayo Clinic in AZ who do the TOPS procedure. I'd love to communicate with someone who has had it done.

@rstark I suspected an allergy to metals when I started having reactions to pierced earrings and I tried all kinds of different metals in the posts and wires and I reacted to everything. For many years they were fine. I developed Hashimotos thyroid disease which is an autoimmune problem, and my environmental medicine doctor advised me to have my old silver filings removed and replaced in my mouth which I did. He said that it was causing the autoimmune thyroid problem. After that, my thyroid function improved and the antibodies were no longer off the charts, but could be measured and were at a low level.

Prior to my spine surgery, I sent a blood sample to Orthopedic Analysis, a lab in Chicago that tests for allergies to implant materials like metals. My test came back negative for everything which surprised me. I still believed it could be a problem, and I chose a C5/C6 fusion because I could do that with only a bone disc spacer and no hardware.

A year after that surgery, I had some old dental work of crowns with root canals go bad. One of them failed and sent an infection into my jaw bone. I saw an oral surgeon who saved that tooth by clearing the infection, and repacking the root. They use cadmium in the gutta percha material that they use which is a heavy metal. A couple years later, another root canal was going bad out of the 4 that I had and they were all old resulting from an injury when I was young. I made the choice to remove all the bad teeth and replace them with ceramic dental implants and new ceramic crowns. This had no metal and as soon as that was out of my body, my health improved immediately and my asthma and breathing improved. That was great until I broke my ankle and had titanium plates fixing the break. 6 months after that surgery, I started getting hives in large patches that broke out anywhere on my body. I was having pain from the hardware and was developing skin pigmentation in the area over the plates. I had them removed and returned to being metal free again. Since I've had the experience of removing all metals from my body, then gaining metals again, and ultimately having them all removed, I have experienced the improvement or worsening of my asthma that accompanied the changes which confirmed my suspicions.

Even if a test says you are not allergic to something, you can later develop an allergy by being exposed to it. With spine surgery, they may use a cage and metal plates on the front of the spine or there are artificial discs that may be a combination of materials and that is likely held in place with titanium screws. I thought about that possibility of hardware embedded in bone because of bone growth around it and didn't know if that could be removed later if there was a problem. Hopefully, I won't have other spine problems that need surgery or implants and I'm doing my best to maintain my spine health and ankle health for that matter. The orthopedic surgeon who fixed my ankle pretty much promised my future would be for an ankle replacement or fusion, and I want to avoid that of course. I work on the muscles to even the tension on my ankle, so I don't have pain and tension in the injured area. That has worked well, although it took me 4 years to figure that out. If something is allowed to be slightly out of alignment, it will add uneven wear and tear which could result in joint replacement surgery down the road. My ankle position can get slightly locked, and I mobilize it so it doesn't catch, and then rotate my foot checking that it's working. That cures a pain and gets it moving better again. Dure to the injury, it isn't perfect although I had a good surgeon fix it at Mayo. It was a bad break that did slightly break the joint space, and injures like this start developing arthritis almost immediately. My PT explained alignment to me, so I pay attention if a new pain begins and then I work out the muscle imbalances that are causing it, or an alignment issue if my pelvis doesn't stay aligned properly. My PT has showed me exercises to help it get back in place.

I am also in Sacramento area. Assume you are referring to Dr. Schrott or Hong. Did you ever proceed with the TOPS procedure. If so, how did it go?

Hi Kathy. Yes, those are the doctors. I'm actually a patient of Dr. Hong's; not interested in going with Schrott. We have not yet scheduled the TOPS but I remain a good candidate per Hong and my MRI from 6/25. I did hear from his office that he has 2 or 3 procedures scheduled in the near future which would bring his number to between 10-15. I have to put it off as I'm looking at an ACDF and a MTP joint fusion first, and I need to change my insurance during open enrollment next month to ensure I'm covered for TOPS (that's a whole different conversation).

If you go through with it, I'd love to hear about your experience. Likewise, if I get it done first, I'd be happy to correspond. If you're comfortable using ChatGPT it will give you a good side-by-side comparison of TOPS and a TLIF. It's the adjacent segment disease that's unsettling.

I have severe spinal stenosis and have been recommended to have a fusion of L4/L5/S1. While at the Mayo Clinic this week, I was told in is possible that the surgeon would do the TOPS procedure, which looks like it would give me much more movement in my lower back. Wondered if anyone else has had this and could tell your experience with it. The nurse told me it would be up to the surgeon, whether or not they would perform that procedure. I’m not sure how to determine whether I’m a good candidate for it and thought others might have some insight into that.