Promising Outcomes for Spinal Stenosis and Spondylolisthesis: An Alternative to Spinal Fusion

Donald Whiting, MD

(Credit: Allegheny Health Network)

When patients suffering from chronic back and leg pain have exhausted all other options, spinal fusion surgery is often the next recommended step. However, spinal fusion surgery can limit movement and permanently restrict activities in patients — and may not provide full relief.

“After you do one fusion surgery, it puts more stress on the vertebrae above and below it,” says Donald Whiting, MD, Chair of the Allegheny Health Network (AHN) Neuroscience Institute. “This additional stress can lead to more wear and tear as well as future fusion surgeries that further limit movement.”

Dr. Whiting has always thought there should be a better option for patients. “Everyone knows that it’s much better to have a hip replacement than to have a hip that doesn’t move,” says Dr. Whiting. “It’s just one of those things that makes intuitive sense, but the joints are so small in the spine it was a bit harder of a problem to solve than a hip and a knee.”

In 2018, the AHN Neuroscience Institute began participating in an FDA clinical trial for a new artificial joint called Total Posterior Spine System (TOPS), which replaces the bony and soft tissues removed during spinal decompression surgery. The TOPS System was approved last year by the FDA for use between L3 and L5 in the lumbar spine, for patients with grade 1 spondylolisthesis, and in cases when the disk in the front of the spine is still healthy.

Whiting scrubbing in surgery.

(Credit: Allegheny Health Network)

The TOPS system offers several advantages over traditional fusion surgery. Unlike spinal fusion surgery, which eliminates all motion at the operative level, the TOPS System preserves mobility of the spine segment and approximates the natural movement of the spine. Because there is less strain on the adjacent levels, it reduces the risk of adjacent level disease. The TOPS System can also be revised if pain or limited range of motion returns.

“Over the last five years, we’ve implanted a number of patients with the TOPS System,” says Dr. Whiting. “They’ve all been able to get back to being very active. It’s given them back their motion and appears to minimize adjacent disease.”

AHN is committed to providing patients with the most advanced and effective treatment options available, including this promising new approach for patients with spinal stenosis and spondylolisthesis.

To refer your patient to the AHN Neuroscience Institute, call 412-359-6200 or email neuroscienceinstitute@ahn.org.