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Spinal TOPS: Revolutionary joint replacement

david kingstrom By david kingstrom | August 11, 2013 | United Kingdom

An amazing new spinal “joint replacement” implant is curing severe back pain by replacing worn-out vertebrae without any of the restrictions on their ability to move that are associated with more traditional treatment.

Thousands of people had surgery to fix damaged vertebrae in the spine that caused back pain because they pinch the spinal cord or touch on nerves.  Until now, one very common solution to the condition, known as spinal stenosis, has been to deal with the problem by "fusing" several vertebrae so they don’t cause any more pain.

But while the surgery had generally very successful, there was a price to pay. The spine can no longer make the full range of movement, so it is more difficult for the patient to bend and twist.

Now Israeli medical scientists have developed the new titanium Total Posterior Solution implant – known as TOPS – that replaces the damaged or worn vertebrae.

The implant is sandwiched into the spine and is a capable of giving the sufferer a full range of movement – without any pain.

 Ron Sacher, who has spent ten years developing TOPS, says many patients with spinal stenosis are relatively young and would like to resume an active life after surgery. 

The surgery only recently arrived in the UK, although, as yet, it is not on offer to patients through the NHS.

 “The most frequent spinal disease in people over-40s is spinal stenosis”  says Sacher, “and that drove our company to find a better option than fusion”.

Dan Plev, one of two spinal surgeons using the implant at the London Spine Clinic, believes the operation is an excellent option.

“A lot of our younger patients are seeking relief from pain but don’t want to be restricted” - he says -  “So we need an option that allows people to resume normal activity  quite quickly.   This implant gets people back to where they want to be within a few weeks”


The TOPS implant not only gives patients normal pain-free mobility – doctors say - it offers protection to adjoining parts of the spine, preventing those bones from collapsing; a common effect of fusion surgery which can lead to even more immobility.

After completing five-year follow-ups on patients from trials in the US, Belgium and Israel, Premia Spine, which makes TOPS, believes its results are significantly better than those achieved by fusion.  The drawback is its relative expense. But its makers say that is balanced by fewer complications than fusion, where  re-surgery rates are 25 per cent compared with five per cent for TOPS.

Mr Plev and a colleague at the London Spine Clinic have carried out eight TOPS operations, with the oldest patient a man in his 90s.

“He had suffered for many years and feels like a new man since the surgery”  - says Mr Plev – “This shows that age is no restriction, although a significant number of our patients are in their  40s and 50s. One of the world’s biggest challenges is back pain. So if we can bring relief through surgery while keeping the spine fully mobile, then we are getting an excellent result”.

The TOPS implant is available at two NHS hospitals – Chase Farm, in Enfield, North London, and Southampton General. The cost is about £20,000. www.londonspineclinic.com


  • Tags:   Spinal TOPS joint replacement spinal stenosis Israeli_medical_scientists titanium_Total_Posterior_Solution_implant TOPS Ron Sacher UK NHS Dan Plev spinal_surgeons London_Spine_Clinic US Belgium Israel Premia_Spine NHS_hospitals Chase_Farm Enfield North_London Southampton_General £20 000
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