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A flexible fix for back pain
Tony Fusco’s back conditions left him desperate for relief. He didn’t think spinal fusion was right for him – until he became the first New York State recipient of a TOPS implant
Tony Fusco didn’t feel like himself, and he wasn’t happy about it. Debilitating and persistent back pain restricted his movements. “I couldn’t bend over to put on my socks,” says the 64-year-old from Yorktown Heights. “To get moving in the morning with the least amount of pain, I’d have to flop both my legs around — like they were tied together — to get into a position to roll myself out of bed. I felt like a walrus!”
Fusco had spinal stenosis — a narrowing of the spinal canal, which houses the spinal nerves and spinal cord. It’s often caused by osteoarthritis. He also suffered from spondylolisthesis, which occurs when vertebrae in the spine slip out of place; a few of his had slid forward. Both conditions can put pressure on the nerves and cause intense pain, numbness and weakness in the legs, says Jonathan Oren, MD, an orthopedic spine surgeon at Northwell Lenox Hill Hospital.
“As the disease progresses, the pain generally will escalate, and people’s function and quality of life diminish,” says Dr. Oren. “That’s usually when they seek treatment.”
The persistence of lower back pain
Lower back pain is an enormous physical, social, mental and economic burden — researchers estimate that 15 to 20% of adults have significant back pain during any given year. For Fusco, the symptoms became intolerable in 2020. In the three years before meeting with Dr. Oren in 2023, Fusco sought advice from six doctors, attempted physical therapy — including core strengthening exercises, massage and electrostimulation — tried chiropractic care, traction and stretching, acupuncture, cupping, nerve blocks and steroid epidurals. The pain always came back.
“A lot of patients reach a point where their bodies don’t respond to physical therapy, injections or oral medications because their stenosis is too severe and the pressure on the nerves just gets too great,” says Dr. Oren. For Fusco, that was a very depressing turning point.
“I was walking to physical therapy, and I caught myself in the window,” says Fusco. “I thought, Oh, my God, I’m an old man. I understand how people get old fast. It kind of hunches you over. You start shuffling. I was depressed. I was getting up later because I was dreading getting out of bed. And I’m saying to myself, Is this my life?”
Considering spinal fusion surgery
When nothing was working for Fusco, the doctors he’d been seeing recommended the standard surgical approach for advanced spinal stenosis: a laminectomy, which would remove the vertebrae pinching the nerve, plus spinal fusion, which stabilizes the spine by permanently joining two vertebrae and eliminating any movement between them.
While this combination is a reliable option that improves function for many, Fusco didn’t think it was right for him. He works with kitchen and bath cabinets, tile and flooring and lives by himself in a third-floor walkup. “They say that after fusion surgery, you’re not supposed to be bending, lifting or twisting for as much as six months so that the bones heal. That’s all I do all day long. I lift boxes, I lift cabinets, I do deliveries,” he says.
“There would be no way that I could survive. I knew I needed something that was going to help me continue my lifestyle.”
Back exercises for everyday wellness
When your spine doesn’t feel right, you don’t feel right. At the Northwell Health Orthopaedic Institute, our spine specialists believe in being proactive about maintaining your back—which means living a healthy, active lifestyle to stop minor aches and pains before they begin.
TOPS procedure: a promising alternative
Fortunately, Fusco, who routinely researched everything he could find about back treatments, had read about a new alternative to spinal fusion. The Total Posterior Spine Surgery (TOPS) System, by Premia Spine, stabilizes the spine without fusing vertebrae together — so it relieves pain but also leaves patients better able to bend, twist and straighten. Fusco met with Dr. Oren to discuss the option.
“For the right patients, the TOPS implant offers an option that allows patients’ back mechanics to work and move in a more normal way,” says Dr. Oren.
Traditional fusion limits movement in a stretch of the spine — a fix that increases pressure on the remaining vertebrae, which can lead to damage or the development of osteoarthritis. In contrast, the TOPS procedure actually replaces the bones that press onto the nerves, using an implant with an internal motion mechanism that provides more range of movement within the lumbar spine. “By preserving movement, there’s theoretically less stress on the discs of the spine above and below the surgery site,” Dr. Oren says.
Following extensive clinical trials, the TOPS system was awarded FDA approval in June 2023.
Is the TOPS procedure right for you?
Good candidates for the TOPS procedure include patients with severe stenosis accompanied by spondylolisthesis in the same area of the spine, Dr. Oren says. They must have bone that is relatively healthy and no other significant issues — such as osteoporosis or a herniated or ruptured disc — in the area.
While TOPS was an ideal option for Anthony Fusco, it’s not right for everyone. “Fusion continues to be a great procedure for many patients,” Dr. Oren says. “It’s necessary for those with spinal deformities, spinal instabilities and different patterns of stenosis or scoliosis. For patients who are not candidates for TOPS, fusion provides them with a reliable surgical solution to improve their quality of life and improve their function.”
In September, Fusco became the first person in New York State to receive the TOPS procedure.
During Fusco’s 2.5-hour surgery, Dr. Oren and orthopedic spine surgeon Peter Frelinghuysen, MD, removed the vertebrae pinching his spinal nerves. Then they screwed in the TOPS implant, which stabilized Fusco’s spine while allowing it to continue moving normally.
Fusco was walking with the help of a physical therapist the next day and out of the hospital in under a week. Within a few weeks, he was able to walk several miles a day — without pain. “It really is amazing,” he says. “I wouldn’t say I’m a ballerina. I’m not doing yoga, but I can touch the floor without bending my legs,” says Fusco. “I can put on my socks, no problem. I can lift, I can twist. As a joke, whenever I see somebody who hasn’t seen me since the operation, I shake my rear end like a duck, if you can imagine. I’m pain-free.”
Dr. Oren is perfectly happy for Fusco to shake his rear — there are no medical restrictions on his movement. He’s learning good lifting and bending techniques, which will help limit the degeneration of other vertebrae and prevent future problems. But the TOPS device has vanquished Fusco’s debilitating pain. “Tony told me he very quickly noticed a big change — he felt like he could move his spine in a way that he hadn’t been able to do in decades,” Dr. Oren says. Today, Fusco is back at work. He tells anyone who’ll listen, “You have to be your own best advocate. Be aware of your options.” He’s an avid evangelist of the TOPS procedure.
“I told Dr. Oren, ‘I’ve been proselytizing. What are those things you see at the car wash waving their hands? That’s me promoting the TOPS procedure as often as I can.’”
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