The TOPS™
Procedure

TOPS stands for Total Posterior Spine System. It is a motion-preserving lumbar implant that stabilizes the spine after a decompression procedure — without fusing the vertebrae. Traditional fusion uses pedicle screws, rods, and cages to permanently lock two vertebrae, eliminating motion at that level. TOPS uses pedicle screws to anchor a mobile mechanical device with internal stoppers that control movement within a calibrated range — providing stability while preserving flexion, extension, lateral bending, and rotation. The nerve decompression is identical; what follows is fundamentally different.

Possibly — and it is always worth a consultation to understand all your options. Dr. Katsevman performs both fusion and the TOPS procedure, and selects the approach based on what is right for each individual patient. Some patients genuinely require fusion, and fusion delivers excellent outcomes when it is the right choice. For patients who meet the TOPS criteria, however, motion can be preserved rather than eliminated. Dr. Katsevman is listed on the official Premia Spine TOPS surgeon locator and will review your imaging to determine which approach is most appropriate for you.

The TOPS System is FDA-indicated for patients between 35 and 80 years of age with symptomatic degenerative spondylolisthesis up to Grade I, combined with moderate-to-severe lumbar spinal stenosis, at one level from L3 to L5. Patients with prior lumbar instrumentation, free fragment disc herniation at the index level, Grade II or higher spondylolisthesis, scoliosis >10 degrees, BMI >40, or active infection are generally not candidates. Dr. Katsevman will review your MRI, CT, and X-rays to determine whether TOPS is appropriate for your specific anatomy and diagnosis.

Spondylolisthesis occurs when one vertebra slips forward on the one below it. In degenerative spondylolisthesis — the type TOPS treats — this slippage is caused by the gradual breakdown of the facet joints and disc that normally hold the vertebrae in alignment. As the vertebra slips, the spinal canal narrows, compressing the nerve roots that travel through it. This produces leg pain, buttock pain, numbness, and weakness, typically worse with walking and standing and relieved by sitting or bending forward. TOPS addresses both the nerve compression (via decompression) and the instability (via the motion implant) simultaneously, without fusion.

Most patients stay one night in the hospital after TOPS surgery. Unlike fusion, there is no waiting for bone to consolidate — the TOPS device provides immediate mechanical stability from the moment it is placed. Recovery typically includes a program of physical therapy and graduated return to activity as guided by Dr. Katsevman. Most patients experience significant improvement in their ability to walk, stand, and participate in daily activities. Because no fusion is required to heal, the recovery trajectory is generally faster than after a comparable fusion procedure.

Coverage for the TOPS System is expanding as it is a newer FDA-approved device. The underlying lumbar decompression is covered by most major insurance plans when medically indicated. Coverage for the TOPS implant specifically is being actively expanded with payers. Dr. Katsevman’s team will verify your benefits, navigate prior authorization, and explore all available options — including out-of-network benefits and GAP exceptions. We work with all insurance plans and are transparent about costs before any decisions are made.

The current FDA indication for TOPS is for one level from L3 to L5. Patients requiring decompression at more than one level, or those with prior lumbar instrumentation, are generally outside the current FDA indication. Dr. Katsevman will carefully review your imaging and if TOPS is not indicated for your anatomy, he will discuss the full range of options available — including other motion-preserving and minimally invasive approaches where applicable.