Have you heard of new "TOPS" Spine surgery?

@sallylang I am in the process of scheduling the TOPS procedure. I'm struggling to find a surgeon that will accept Medicare, even though it is Medicare approved. Most surgeons are wanting cash. I have a patient advocate from Premia Spine, who makes the device, and she is equally frustrated.

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.

@brennankb55 I was in the same condition that you are and I had lumbar fusion and all the bells and whistles and it was 100% successful. Unfortunately, by the time I found my dream orthopedic surgeon. I had permanent damage on my flattened nerve root. As long as you have your Prince charming of an orthopedic surgeon I’d suggest going for what they recommend. My surgeon did all the revisions on the other surgeons bad work. I knew I was in good hands.

Yes I do Annie. I was diagnosed about 9 years ago. Like so many others I was given fosomax/alendronate for the maximum of 5 years. Then forteo for 2 years. After that 1 year of Evenity . I have had 1 shot of Prolia and will do 1 more. I July I am seeing another endocrinologist to see if he will recommend a short/light infusion of reclast then another bone builder like tymlos, forteo or evenity. I don't feel ready at 77 to stay on Prolia for the rest of my life. I'd like to see if he thinks this might work for me. My sequence of drugs is not something I would repeat if I had had more knowledge. In retrospect I would have started with a a bone builder rather than a bisphosphonate which can impede the work of bone builders. I also started bhrt about 8 months ago but not because I thought it would have much positive impact on my bones. If it helps great but I do not believe that it will mean I don't have to continue with osteoporosis meds. I have not really had side effects with any med. Any aches I consider to be the medication doing its job. Good luck to you.

@ou14mejc
I am having a consultation about getting the TOPS but I have read, albeit on AI that it cannot work if you have osteoporosis. Which I do. I called premia spine to ask what they say but it's really hard to get an answer. They were supposed to call me back twice and they never have. I'll try again today.

@gravity3
I had severe osteoporosis and had 18 months of Tymlos. My scan showed I was at osteopenia.
My endocrinologist now has me on Evenity for a year. Prior to Tymlos, the surgeons would not touch me due to the osteoporosis. Now I am looking at extensive spinal surgery,

@loriesco
How do you know when you have permanent nerve damage? I'm worried about that because I've had stenosis for 7 years and I did have a decompression surgery that only worked for 2 months literally. Now they say I need fusion there's one surgeon who is saying he thinks I could have the tops procedure. Where did you have your surgery done if I might ask since you feel very positive about your surgeon? Thank you and I definitely would like to know how the doctors can tell if you have permanent nerve damage. But your surgery helped I'm assuming?