Seven years follow-up for total lumbar facet joint replacement (TOPS) in the management of lumbar spinal stenosis and degenerative spondylolisthesis.
OBJECTIVE
To evaluate the feasibility and clinical improvement of a total posterior arthroplasty system in the surgical management of lumbar degenerative spondylolisthesis and or spinal stenosis.


METHODS
During a 1-year period (June 2006 to July 2007), ten patients were enrolled in a non-randomized prospective clinical study. The primary indication was neurogenic claudication due to spinal stenosis with single-level degenerative spondylolisthesis. Patients were evaluated with X-rays and MRI scans, visual analog scale (VAS) for back and leg pain, the Oswestry disability questionnaire, and the SF-36 health survey preoperatively, at 6 weeks, 3 months and 6 months and at 1, 2, 3 and 7 years postoperatively.


RESULTS
The VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 19 at 7 years follow-up. The VAS score for worse leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 8.8 at 7 years follow-up. The ODI dropped from 49.1 preoperatively to 13.5 at 6 weeks and 7.8 at 7 years follow-up. MRI examination at 7 years after surgery did not demonstrate stenosis adjacent to the stabilized segment. Spondylolisthesis did not progress in any of the cases. One patient had a symptomatic L3-L4 far lateral disc herniation 5 years after surgery whose symptoms resolved with non-operative treatment. In one patient, conversion to posterolateral fusion was performed due to an early device malfunction.


CONCLUSIONS
In patients with spinal stenosis and degenerative spondylolisthesis, decompression and posterior arthroplasty with the TOPS System can maintain clinical improvement and radiologic stability over time.
The Spine Unit, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.|Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Yoram
Y
Anekstein
Israel Spine Center at Assuta Hospital, Tel Aviv, Israel.
Yizhar
Y
Floman
The Spine Unit, Assaf Harofeh Medical Center, Zerifin, 70300, Israel. Noam_Yossi@yahoo.com.|Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Noam_Yossi@yahoo.com.
Yossi
Y
Smorgick
Israel Spine Center at Assuta Hospital, Tel Aviv, Israel.
Nahshon
N
Rand
Israel Spine Center at Assuta Hospital, Tel Aviv, Israel.
Michael
M
Millgram
Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.|Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Yigal
Y
Mirovsky
D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*; D021801:Zygapophyseal Joint / Q000601:surgery*
Degenerative spondylolisthesis; Neurogenic claudication; Spinal stenosis; TOPS