Total Posterior Spine System (TOPS) Lumbar Facet Arthroplasty - Novel Method for Managing Adjacent Segment Disease: Case Report

Introduction:

Background: Adjacent Segment Disease (ASD) is a major postoperative complication frequently seen in patients who have undergone spinal fusion surgery. The Total Posterior Spine System (TOPS) facet replacement system has been developed as an alternative to lumbar fusion surgery with intended advantages in maintenance of spinal mobility and theoretically decreased risk for ASD. TOPS was recently FDA-approved for Lumbar Degenerative Spondylolisthesis (LDS) (up to Grade-I) with lumbar spinal stenosis (LSS). Additionally, it has also been proposed for patients with post-fusion ASD.

Purpose: This report presents the case of a man who underwent multiple lumbar fusions, presented with ASD, and was subsequently treated with TOPS implantation.

Methods:

Case Description: A 43-year-old male who had previously undergone a lumbar 4 to lumbar 5 Transforaminal Lumbar Interbody Fusion (TLIF) and lumbar 5 to sacral 1 Anterior Lumbar Interbody Fusion (ALIF) presented 2 years later with persisting axial and radicular pain and leg numbness. Imaging revealed ASD, with instability and stenosis at lumbar 3 to lumbar 4. Following a detailed discussion of surgical options, the patient was deemed a suitable candidate for TOPS facet arthroplasty. This intervention was elected over undergoing an additional fusion due to the patient's surgical history and highly active lifestyle.

Results: Preoperatively, this patient reported having debilitating lower back pain that radiated down his leg and was exacerbated during ambulation. Following a TOPS facet arthroplasty, the patient was able to return to normal activity with completely resolved back pain by his 3-month follow-up. Post-operative course was normal and without complications.

Conclusion : Although TOPS is currently FDA-approved for Grade 1 LDS and LSS, we believe our case provides support for TOPS as a treatment option with potential for addressing ASD, a common complication associated with spinal fusion.