The article by Ament et al1 examining the combination use of total disc replacement and the total posterior facet replacement system (TOPS, Premia Spine) is a step forward in the clinical approach toward functional spinal unit replacement or reconstruction. Whereas total disc replacement devices are mechanical substitutes for anterior column degenerative disorders, the TOPS device affords correction of posterior spinal column deficiencies. Both products are now US Food and Drug Administration–approved for individual use, but they have not been tested for combination use.
Both devices preserve, augment, or re-create motion. The TOPS device, through design, also limits anterior translation. While neither device was specifically tailored for use with the other, both offer a broad range of clinical applicability and may complement each other.
Significant issues would need to be addressed and understood before this combination is more widely used. One concern is whether the biomechanical parameters of each individual device are compatible with the other. Another concern is the cost and specific indications for this type of therapy. Finally, these or similar mechanical therapies may provide a bridge for the treatment of degenerative disc disease if biological therapies become available in the future.
Footnotes
Funding The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests The author reports no conflicts of interest in this work.
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2025 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
References
- 1.↵Ament JD , Petros J , Gardner C , Vokshoor A . The first grade III lumbar spondylolisthesis treated with the novel 360° artificial disc/artificial facet replacement solution. Int J Spine Surg. 8769. 10.14444/8769
