TOPs Procedure

@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 . . .

@rstark It's also worth asking what other procedures can address your issues, and the pros and cons with each. You need to evaluate the risk of possible issues to try to forecast your prognosis down the road after a procedure. No one wants spine surgery, but if you have to do it, it makes sense to consider the future and if your first surgery will limit choices in the future if something else needs to be addressed surgically.

You also need information about failure rates for an implanted device and understanding of how or why that happens in relation to any other medical issues that you have. I look up the manufacturers website and read about the device. You can also search for medical journals with write ups about it . Make sure to also search with the term "failure" to see if there are any hits for information.

They can migrate....Not good when they do

This was a good presentation: https://www.youtube.com/watch?v=jOD2kcpM8SM the data presented at about 4:30 to about the 8 minute mark seems to address success rates.

@rstark I’m glad to see you are researching this and watching medical presentations geared for surgeons. I did that too and you can learn a lot. I’m also happy to see this is a presentation from Cleveland Clinic as they are well respected and similar to Mayo. If you watch this and pause, you can try to look up some of the detailed information since it goes by pretty fast. One of the key takeaways is your disc must not be collapsed to use this device, so that seems to be an early intervention as opposed to years later with collapse and bone spurs. They don’t have a lot of data past 7 years. One point they made was less back pain because the spine moves better if not fused. A couple reasons I chose fusion was that my body reacts to foreign materials like metals which has been a problem with titanium. Some people are allergic to it. Bone quality matters for any spine surgery, but more when there are only screws holding an implant in place without any area that can anchor with bone growth. It sounds hopeful since you are a great candidate and with a second chance reoperation option as long as you are not too old for spine surgery or in poor health when that time comes. In making a decision, you weigh the pros and cons, and take your best shot. It’s always a decision where you knowledge of the future is limited, but you find out how you can help increase you chances of success.

@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.