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Familiar with "TOPS" spine surgery?

Spine Health | Last Active: Jul 6 7:30am | Replies (73)

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Profile picture for johnfm @johnfm

I had the L4-5 TOPS procedure done last March 31, 2025; here in Milwaukee. I woke up from the surgery pain free. It was very successful. Completely off Gabapentin immediately after weaning off of it. No rehab needed. 3 months to full recovery. I think it might be FDA approved since it is done with the clinical trials stage in the US.
****HOWEVER; it is not covered by Medicare at this time so I had to pay out of pocket for the hardware that was installed. Most private insurances follow Medicare guidelines, so I assume most other insurances are not covering it. The denial by Medicare has been appealed many times without success.
The only problem following surgery was that I developed significant burning pain in the buttocks, bilaterally 2 months post surgery. The burning pain only occurs when sitting on softer surfaces such as the recliner, car seat, and reading in bed. MRI showed a severe stenosis at the level above the surgery. The surgeon has offered to do a laminectomy but I prefer to not go under the knife again so soon. There has been little improvement after 2 injections; 2 rounds of PT, acupressure, and using a low dosage of Gabapentin. I am scheduled to see a different spine pain specialist next week for any ideas and discussion on any further approaches to resolve this issue, without surgery, if possible.

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Replies to "I had the L4-5 TOPS procedure done last March 31, 2025; here in Milwaukee. I woke..."

@johnfm I'm surprised they didn't do a laminectomy when they implanted the TOPS device. I can't blame you for not wanting another surgery so soon....just wondering how they missed that? I am also puzzled as to why this cost isn't being covered. The device was approved by the FDA in 2023 and it is covered by Medicare. What I am hearing is that surgeons aren't happy with what Medicare is paying so they are asking for cash only at many surgery centers. Hope you get your pain resolved and thanks for sharing.

@johnfm
That's too bad that you developed a new pain after the surgery but I hear that's common especially with fusion. Since your name is John I'm assuming you are male and therefore most likely you don't have osteoporosis. I have read that the tops device might not be safe if you have osteoporosis which I do. Of course it's not that safe to do fusion either with osteoporosis. But any information you have on that I would like to know and I hope you find someone who can help you with the burning pain.