Demonstrating the feasibility of facet arthroplasty using the Total Posterior Spine System (TOPS) in the ambulatory surgery center (the TOPS outpatient experience).

Abstract

Background: The transition to the outpatient/ambulatory setting is especially important within value-based care system. While some procedures are well supported, posterior motion-preserving technologies, such as Total Posterior Spine System (TOPS), a novel artificial facet replacement, have yet to be evaluated in an ambulatory surgery center (ASC) setting. The objective of this study is to assess the feasibility, safety and early outcomes of the TOPS device in an ASC setting.

Methods: In this retrospective case series, we reviewed 30 consecutive patients who underwent TOPS implantation at a free-standing ASC between September 2023 and December 2025. Demographics, intra-operative metrics, discharge data, 90-day events and patient-reported outcome measures (PROMs) were collected from operative/anesthesia reports and the electronic medical record.

Results: Thirty patients were included; 14 males and 16 females, with a mean age and body mass index (BMI) of 62 years and 27±5 kg/m², respectively. Mean estimated blood loss was 278±65.2 mL and mean operative time was 206±52 minutes. All patients were discharged the same day; 63% home, 37% to an after-care facility. There were no hospital admissions. Within 90 days three revision surgeries (10%) occurred for device malposition (n=2) and seroma drainage (n=1). By six months, mean visual analog scale (VAS) back pain decreased by 67.3%, right leg VAS by 93.8%, left leg VAS by 98.6%. Oswestry Disability Index (ODI) improved by 71.5%, and patient-reported outcome measurement information system (PROMIS) physical increased by 27.6%, and PROMIS mental by 13.8%. Mean patient satisfaction rose from 7.1/10 at six months to 9.8/10 at twelve months.

Conclusions: This series demonstrates that TOPS facet arthroplasty can be safely and effectively performed in a free-standing ASC.