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Has anyone had the TOPS surgery through Premia Spine website?
Recent MRI states: L1-L2: Minimal symmetric disc bulge, which along with facet arthropathy, prominence of ligamentum flavum, prominence of the dorsal epidural fat contributes to mild thecal sac stenosis, increased from prior. Adequate neural foramina
L2-L3: Disc bulge is asymmetric to the right, which along with facet arthropathy, prominence of ligamentum flavum, and prominence of the dorsal epidural fat contributes to mild thecal sac stenosis, increased from prior. Adequate neural foramina
L3-L4: Symmetric disc bulge, which along with facet arthropathy, prominence of ligamentum flavum, and prominence of the dorsal epidural fat contributes to severe thecal sac stenosis, slightly increased from prior. Associated crowding of the cauda equina nerve roots (series 5 image 22). Adequate neural foramina
L4-L5: Anterolisthesis L4 on L5 with uncovering of disc material. Superimposed symmetric disc bulge, which along with facet arthropathy, prominence of ligamentum flavum, prominence of the dorsal epidural fat contributes to severe thecal sac stenosis, increased from prior. Subarticular recesses are completely effaced and there is crowding of the cauda equina nerve roots. Moderate left and mild right neural foraminal narrowing
L5-S1: Adequate thecal sac. Bilateral facet arthropathy with adequate neural foramina. Tiny (0.2 cm) right-sided facet synovial cyst directed toward the spinal canal and neural foramen, but does not contribute to any significant spinal canal or neural foraminal stenosis
IMPRESSION:
1. Interval increase in multilevel degenerative changes of the lumbar spine with superimposed epidural lipomatosis, now with severe thecal sac stenosis at L3-L4 and L4-L5, mild thecal sac stenosis at L1-L2 and L2-L3, and multilevel mild or moderate neural foraminal narrowing, as detailed. Wondering if anyone had TOPS instead of fusion, and how has the back been since the surgery?
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I haven't had it done personally but I've been following the device since before it came to the US. I'm very intrigued in it as well. I'm curious to find out if you have any luck moving forward with it.
I have an appointment with Dr. Shaleen Vira on 3/17. He is trained in TOPS. He did a video talk for Premia Spine yesterday. I don't know if I qualify, but I will find out. I will update you after I see him.
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1 Reaction@sallylang Thanks, I appreciate it. Look forward to your update! I know Mayo Clinic was one of the very first health systems in the US to get training on it and be able to do the surgery. So that's promising for you!! I looked into flying to Germany for it before it was in the US but decided it was too much work (& money) so I'd just wait until it was approved by the FDA.
@readinglamb- I saw Dr. Shaleen Vira today. He said I am not eligible for the TOPS surgery because my bones are to thin. I am 76 years young and do have Osteopenia. Looks like I am a candidate for fusion for my spine problems.
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.
I do strongly agree with the theory of the TOPS procedure in that it does allow some (very little but some ) range of motion within the segment involved; so theoretically is will reduce the increased stress on the vertebra at either ends outside where a fusion would be done. I was told by two surgeons that my only options for my spinal condition was either the TOPS or a fusion. I was told by both surgeons that a fusion would take a full year to heal.
*I was informed by the surgeons office that Medicare may not pay for the hardware; but with only a 3 month full healing time with the TOPS procedure, I felt getting 9 months back in my life was worth paying for the non covered portion of the surgery. Note, because the procedure is relatively new, the long term results are not published yet.
@johnfm Thank you for sharing your experience with me. I did not realize Medicare would not pay for the hardware. Insurance coverage would have been my next step had I been a candidate. Now I need to learn more about fusion.